分析早期支气管镜治疗对重症脑外科术后患者肺部感染预防和降低病死率的价值。

采用随机分组法，将2017年1月至2019年9月由浙江大学医学院附属金华医院急诊行脑外科手术，术后转入重症监护病房治疗，并机械通气时间超过24 h的患者分为观察组和对照组。对照组由临床医师根据病情给予处理，并按需给予常规吸痰治疗；观察组在对照组基础上于术后24 h内首次给予床旁支气管镜吸痰加灌洗治疗，之后按需给予床旁支气管镜吸痰加灌洗治疗。比较2组间早期肺部感染发生率及28 d病死率。

共入组246例，男144例（58.54%），女102例（41.46%）；年龄19~94岁，平均（58.52±14.42）岁；脑出血142例（57.72%），脑梗死15例（6.10%），脑外伤89例（36.18%）。111例行床旁支气管镜治疗，观察期内每例行床旁支气管镜治疗1~5次，平均（1.97±1.20）次。共68例继发早期肺部感染，总发生率27.64%，其中，观察组27例（发生率24.32%），对照组41例（发生率29.63%），差异无统计学意义（P＞0.05）。87例于28 d内死亡，总全因病死率35.37%，其中，观察组33例（病死率29.73%），对照组54例（病死率40.00%），差异无统计学意义（P＞0.05）。亚组分析显示，脑外伤亚组中观察组较对照组肺部感染发生率差异有统计学意义（17.02% vs 38.10%，P=0.025）；脑出血亚组中观察组较对照组28 d病死率差异有统计学意义（20.69% vs 39.29%，P=0.019）。观察组中继发早期肺部感染患者血炎症指标峰值较对照组明显下降，差异有统计学意义（P＜0.05）。

早期支气管镜吸痰和灌洗治疗有助于降低脑外伤患者的肺部感染发生率及脑出血患者的病死率，有助于减轻重症脑外科患者早期肺部炎症反应，减少毒素吸收，有利于肺部感染的控制，值得临床推广应用。

To evaluate the value of early bronchoscopy intervention for prevention of early pulmonary infection and reduction of death rate in patients with severe brain surgery.

From January 2017 to September 2019, patients admitted to Neurosurgical Intensive Care Unit, Affiliated Jinhua Hospital, Zhejiang University School of Medicine after emergency brain surgery and ventilated for more than 24 hours were enrolled into this study. They were randomly divided into a treatment group and a control group. The control group was treated by the clinician according to the condition and given routine sputum suction treatment as needed. In the observation group, on the basis of the treatment for the control group, sputum aspiration and lavage with a bedside bronchoscope were given for the first time within 24 hours after operation, and then, as required, sputum aspiration and lavage with a bedside bronchoscope were given. Early pulmonary infection rates and 28-day mortality were compared between the two groups.

A total of 246 patients were enrolled, of whom 144 were male and 102 were female. They ranged in age from 19-94 years, with an average age of (58.52±14.42) years. The diagnoses included cerebral hemorrhage in 142 (57.72%) patients, cerebral infarction in 15 (6.10%), and cerebral trauma in 89 (36.18%). During the observation period, 111 patients were treated by bedside bronchoscopy for 1-5 times, with an average of (1.97±1.20) times. Sixty-eight patients had pulmonary infection with an overall infection rate of 37.64%, among whom 27 (24.32%) were in the treatment group and 41 (29.63%) in the control group, with no statistically significant difference between the two groups (P＞0.05). Eighty-seven patients died in 28 days after admission, with an overall mortality of 35.37%, among whom 33 (29.73%) were in the treatment group and 54 (40.00%) in the control group, with no statistically significant difference between the two groups (P＞0.05). Sub-group analysis revealed that the infection rate of patients with brain trauma (17.02% vs 38.10%) and the death rate of patients with cerebral hemorrhage (20.69% vs 39.29%) in these two groups had statistical differences (P=0.025 and 0.019, respectively). The peak value of blood inflammation index in patients with early secondary pulmonary infection in the observation group was significantly lower than that of the control group (P＜0.05).

Early bronchoscopic sputum aspiration and lavage can help to reduce the rate of early pulmonary infection of patients with brain trauma, the mortality of patients with cerebral hemorrhage, and early pulmonary inflammatory reaction and absorption of toxins in patients with severe brain surgery and is worthy of clinical promotion.