内科

目的探讨改良急诊床旁肺部超声检查（BLUE-plus）方案联合支气管肺泡灌洗术（BAL）在重症监护病房（ICU）肺不张患者中的应用效果。方法选取2022年2月至2023年10月广西壮族自治区人民医院重症医学科收治的60例肺不张患者作为研究对象，采用随机数字表法将其分为对照组和观察组，每组30例。对照组接受肺部CT指导下的BAL治疗，观察组接受肺部CT联合BLUE-plus方案指导下的BAL治疗。比较两组患者治疗前后的血气分析指标［动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（OI）］、感染指标［白细胞计数、降钙素原（PCT）］、肺部超声评分（LUS），以及机械通气时间。结果治疗前，两组PaO2、PaCO2、OI、白细胞计数、PCT水平及LUS差异均无统计学意义（均P>0.05）。治疗后，两组PaO2、OI均较治疗前升高，PaCO2、白细胞计数、PCT水平及LUS均较治疗前降低（均P<0.05）；观察组PaO2、OI均高于对照组，PCT水平及LUS均低于对照组（均P<0.05）。观察组机械通气时间短于对照组（P<0.05）。结论 BLUE-plus方案能动态精准识别肺不张发生部位，在其引导下进行BAL是治疗ICU患者肺不张的有效方法，可有效地控制局部感染改善患者氧合功能、减轻肺部病变程度并缩短机械通气时间，值得在临床中推广应用。

Objective To explore the application effect of the bedside lung ultrasonography in emergency-plus (BLUE-plus) protocol combined with bronchoalveolar lavage (BAL) in patients with atelectasis in the intensive care unit (ICU). Methods A total of 60 patients with atelectasis admitted to the Department of Critical Care Medicine, the People's Hospital of Guangxi Zhuang Autonomous Region, from February 2022 to October 2023 were selected as the research subjects, and they were divided into a control group or an observation group using the random number table method, with 30 cases in each group. The control group received pulmonary CT-guided BAL treatment, while the observation group received BAL treatment under the guidance of pulmonary CT combined with the BLUE-plus protocol. The following parameters were compared between the two groups: blood gas analysis indicators (arterial partial pressure of oxygen [PaO2], arterial partial pressure of carbon dioxide [PaCO2], and oxygenation index [OI]), infection indicators (white blood cell count and procalcitonin [PCT]), and lung ultrasound score (LUS) before and after treatment, as well as duration of mechanical ventilation. Results Before treatment, there was no statistically significant difference in PaO2, PaCO2, OI, white blood cell count, PCT level, or LUS between the two groups (all P>0.05). Compared with those before treatment, the PaO2 and OI were higher in both groups after treatment, and the PaCO2, white blood cell count, PCT level, and LUS were lower in both groups after treatment (all P<0.05); the PaO2 and OI were higher and the PCT level and LUS were lower in the observation group than in the control group after treatment (all P<0.05). The duration of mechanical ventilation in the observation group was shorter than that in the control group (P<0.05). Conclusion The BLUE-plus protocol enables dynamic and precise localization of atelectasis. Performing BAL under its guidance is an effective method for treating atelectasis in ICU patients. This approach can effectively control local infections, improve patients' oxygenation, reduce the severity of lung lesions, and shorten the duration of mechanical ventilation, which is worthy of clinical promotion and application.