Objective: To explore the clinical effects of fiberoptic bronchoscopy airway lavage (FBAL) in the treatment of extremely severe burn patients with severe inhalation injury. Methods: From January 2015 to January 2019, 47 extremely severe burn patients with severe inhalation injury who were hospitalized in Tongren Hospital of Wuhan University & Wuhan Third Hospital, meeting the inclusion criteria, were recruited in this retrospective cohort study. According to whether or not they were treated with FBAL, the patients were divided into fiberoptic bronchoscopy group (23 cases, 19 males and 4 females) and routine group (24 cases, 20 males and 4 females), with the age of (44±11) and (49±9) years, and the admission time of 4 (3, 4) h and 4 (3, 5) h respectively. The patients in routine group were given routine comprehensive treatment, and the patients in fiberoptic bronchoscopy group were treated with FBAL on the basis of routine comprehensive treatment. The pH value, arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial oxygen saturation (SaO(2)), oxygenation index, white blood cell count (WBC), neutrophils, blood lactic acid, and procalcitonin (PCT) at admission and on post injury day (PID) 3, 5, 7, and 10, the time of mechanical ventilation, the day of intensive care unit (ICU) stay, the incidence of complications and death within PID 28 were compared between the two study groups. The occurrences of bronchospasm and asphyxia of patients in fiberoptic bronchoscopy group were monitored. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, Bonferroni correction, chi-square test, and Fisher's exact probability test. Results: (1) At admission, the values of pH, PaO(2), PaCO(2), SaO(2), and oxygenation index of patients in the two groups were similar (Z=-0.118, -0.320, -0.362, -2.416, -0.234, P>0.05). On PID 3, 5, 7, and 10, the values of pH, PaO(2), SaO(2), and oxygenation index of patients in fiberoptic bronchoscopy group were significantly higher than those of routine group (Z(3 d)=-4.711, -4.161, -5.525, -2.661; Z(5 d)=-3.489, -4.678, -5.875, -3.599; Z(7 d)=-5.104, -4.619, -5.876, -4.844; Z(10 d)=-4.026, -5.698, -5.877, -4.716; P<0.05 or P<0.01). The PaCO(2) values of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group (Z=-2.895, -3.162, -3.407, -2.831, P<0.05 or P<0.01). (2) At admission and on PID 3, 5, and 7, the values of WBC, blood lactic acid, and PCT of patients in the two groups were similar (Z=-0.830, -0.915, -0.458, -0.648, -1.714, -1.479; -0.330, -0.128, -1.766, -0.494, -1.396, -1.522, P>0.05). On PID 10, the values of WBC, blood lactic acid, and PCT of patients in fiberoptic bronchoscopy group were significantly lower than those of routine group (Z=-3.502, -2.630, -2.662, P<0.05 or P<0.01). At admission, the value of neutrophils of patients in fiberoptic bronchoscopy group was 0.887 (0.862, 0.912), which was similar to 0.887 (0.856, 0.897) in routine group (Z=-0.404, P>0.05). On PID 3, 5, 7, and 10, the values of neutrophils of patients in fiberoptic bronchoscopy group were respectively 0.848 (0.802, 0.867), 0.831 (0.815, 0.849), 0.798 (0.771, 0.849), 0.796 (0.751, 0.869), which were significantly lower than those of routine group [0.882 (0.820, 0.906), 0.871 (0.835, 0.903), 0.845 (0.819, 0.905), 0.881 (0.819, 0.916), Z=-2.756, -2.810, -2.618, -3.033, P<0.05]. (3) The time of mechanical ventilation and the days of ICU stay of patients were shorter in fiberoptic bronchoscopy group than those in routine group (Z=-2.199, t=2.368, P<0.05). Within PID 28, the number of patients with complications was significantly less in fiberoptic bronchoscopy group than in routine group (χ(2)=5.436, P<0.05), while the incidence of death within PID 28 in fiberoptic bronchoscopy group was similar to that of routine group (P>0.05). The airway lavage procedures of patients in fiberoptic bronchoscopy group went well with no bronchospasm or asphyxia occurred. Conclusions: FBAL is effective in treating extremely severe burn patients combined with severe inhalation injury. It can improve the oxygenation status of the lung, reduce the systemic inflammatory reaction of patients, shorten the time of mechanical ventilation and ICU stay, and reduce the incidence of complications.
目的： 探讨纤维支气管镜气道灌洗治疗在特重度烧伤合并重度吸入性损伤中的临床效果。 方法： 将2015年1月—2019年1月武汉大学同仁医院暨武汉市第三医院收治的符合入选标准的47例特重度烧伤合并重度吸入性损伤患者纳入本回顾性队列研究。根据是否行纤维支气管镜气道灌洗治疗分为纤维支气管镜组23例[男19例、女4例，年龄(44±11)岁，伤后4(3，4)h入院]和常规组24例[男20例、女4例，年龄(49±9)岁，伤后4(3，5)h入院]。常规组予以常规综合治疗，纤维支气管镜组在常规综合治疗基础上行纤维支气管镜气道灌洗治疗。统计2组患者入院时及伤后3、5、7、10 d pH值、动脉血氧分压(PaO(2))、动脉血二氧化碳分压(PaCO(2))、动脉血氧饱和度(SaO(2))、氧合指数，白细胞计数、中性粒细胞、血乳酸、降钙素原，机械通气时间、住ICU天数、伤后28 d内的并发症发生及死亡情况。观察纤维支气管镜组患者行纤维支气管镜气道灌洗治疗过程中是否发生支气管痉挛及窒息。对数据行独立样本t检验、Mann－Whitney U检验并行Bonferroni校正、χ(2)检验、Fisher确切概率法检验。 结果： (1)入院时，2组患者pH值、PaO(2)、PaCO(2)、SaO(2)及氧合指数相近(Z＝－0.118、－0.320、－0.362、－2.416、－0.234，P>0.05)。伤后3、5、7、10 d，纤维支气管镜组患者pH值、PaO(2)、SaO(2)及氧合指数均明显高于常规组(Z(3 d)＝－4.711、－4.161、－5.525、－2.661，Z(5 d)＝－3.489、－4.678、－5.875、－3.599，Z(7 d)＝－5.104、－4.619、－5.876、－4.844，Z(10 d)＝－4.026、－5.698、－5.877、－4.716，P<0.05或P<0.01)，纤维支气管镜组患者PaCO(2)明显低于常规组(Z＝－2.895、－3.162、－3.407、－2.831，P<0.05或P<0.01)。(2)入院时及伤后3、5、7 d，2组患者白细胞计数、血乳酸及降钙素原水平相近(Z＝－0.830、－0.915、－0.458，－0.648、－1.714、－1.479，－0.330、－0.128、－1.766，－0.494、－1.396、－1.522，P>0.05)；伤后10 d，纤维支气管镜组患者白细胞计数、血乳酸及降钙素原水平均明显低于常规组(Z＝－3.502、－2.630、－2.662，P<0.05或P<0.01)。入院时，常规组、纤维支气管镜组患者中性粒细胞相近[0.887(0.862，0.912)、0.887(0.856，0.897)，Z＝－0.404，P>0.05]；伤后3、5、7、10 d，纤维支气管镜组患者中性粒细胞[0.848(0.802，0.867)、0.831(0.815，0.849)、0.798(0.771，0.849)、0.796(0.751，0.869)]均明显低于常规组[0.882(0.820，0.906)、0.871(0.835，0.903)、0.845(0.819，0.905)、0.881(0.819，0.916)，Z＝－2.756、－2.810、－2.618、－3.033，P<0.05]。(3)纤维支气管镜组患者机械通气时间和住ICU天数明显短于常规组(Z＝－2.199，t＝2.368，P<0.05)，伤后28 d内的并发症发生患者数明显少于常规组(χ(2)＝5.436，P<0.05)，伤后28 d内的死亡患者数与常规组相近(P>0.05)。纤维支气管镜组患者气道灌洗操作过程顺利，均未发生支气管痉挛或窒息。 结论： 纤维支气管镜气道灌洗治疗特重度烧伤合并重度吸入性损伤患者效果明显，可快速改善肺部的氧合状态和减轻机体炎症反应，缩短机械通气和住ICU时间，并减少并发症发生。.
Keywords: Airway lavage; Airway management; Blood gas analysis; Burns, inhalation; Fiber bronchoscope; Neutrophils; Oxygenation index.