Objective To observe influence of auxiliary treatment of bronchoscopy alveolar lavage on respira-tory mechanics index and infection control effect in patients with severe ventilator associated pneumonia(VAP). Methods 84 cases of severe VAP patients were randomly divided into the observation group (n =42 cases)and con-trol group (n =42 cases),control group was given antibiotics and conventional sputum suction lavage treatment,the observation group was given bronchoscopy alveolar lavage and antibiotics.Clinical pulmonary infection score (CPIS) and serum calcitonin level (PTC)were recorded in the two groups before and after treatment.Respiratory mechanics indexes such as the dynamic compliance (Cdyn),the airway peak pressure (PIP),work of breathing (WOB)and airway resistance (Raw)were measured in the two groups before and after bronchoscopy alveolar lavage,and the clin-ical efficacy of two groups were compared.Results CPIS of the observation group (6.37 ±1.31),(5.42 ±1.13), (3.52 ±0.53)was significantly lower than that of the control group (7.72 ±1.56),(7.14 ±1.33),(5.13 ± 0.94)(t =4.295,6.387,5.821,all P <0.05 )after 3,5,7d treatment.PTC of the observation group ((4.71 ± 0.85)μg/L,(2.65 ±0.61 )μg/L,(0.62 ±0.23)μg/L)were significantly lower than those of the control group (5.10 ±0.92)μg/L,(3.96 ±0.72)μg/L,(1.31 ±0.43)μg/L(t =4.295,6.387,5.821,all P <0.05)after 3,5, 7d treatment.Cdyn of the observation group after 1 and 4h bronchoscopy alveolar lavage (35.39 ±6.39),(35.59 ±5.83)were high those of the control group (26.82 ±4.63),(25.64 ±4.28)(t =7.038,-10.462,all P <0.05);WOB (10.08 ±0.45),(8.10 ±0.38),PIP(21.28 ±2.76),(15.29 ±1.67)and Raw (10.08 ±0.45),(8.10 ± 0.38)in the observation group after 1and 4h bronchoscopy alveolar lavage were lower those in the control group WOB (0.63 ±0.17),(0.49 ±0.12),Raw(13.49 ±0.50),(11.42 ±0.42),PIP(27.38 ±3.10),(23.44 ±2.60)(1h:t =9.681,3.937,32.853,all P <0.05;4h:t =12.231,6.064,6.313,all P <0.05).Total effective rate of the obser-vation group was obviously higher than that of the control group after treatment (93.3% vs.77.8%,chi -square =5.486,P <0.05).Conclusion Auxiliary treatment of bronchoscopy alveolar lavage has clinical curative effect in patients with severe VAP,the method can effectively decreased PTC level of VAP patients,to acquire lung infection control,and improve the respiratory mechanics parameters.

Objective To analyze the level of post-traumatic stress disorder(PTSD)and its risk factors in patients with ischemic stroke.Methods A total of 183 cases of patients with ischemic stroke treated in Putuo District People's Hospital of Zhoushan City from May 2020 to June 2022 were selected as the observation objects.Basic information of patients was collected by self-made questionnaire,including gender,age,personality characteristics,family per capita monthly income,education level,marital status,ability of daily living,duration of ischemic stroke,family function,type of medical insurance,whether there was swallowing dysfunction,whether there was underlying disease(heart disease,hypertension,hyperlipidemia and diabetes),whether there is anxiety,coping style,level of social support.PTSD self-rating scale(PTSD-SS)was used to determine the complications of PTSD in ischemic stroke patients,and the incidence of PTSD was calculated.To compare the difference in basic information between the two groups of patients with PTSD.Factors with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to screen out the risk factors affecting the development of PTSD in patients with ischemic stroke,and receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for the development of PTSD in patients with ischemic stroke.Results PTSD-SS score of 183 patients with ischemic stroke(48.76±9.21)was relatively low.Among them,37 case(20.22%)of patients developed PTSD.Compared with the non-PTSD group,the proportion of patients with introverted personality,dysfunctions of daily living,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support was significantly increased in the PTSD group(all P＜0.05).Multivariate Logistic regression analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support were independent risk factors for PTSD in ischemic stroke patients[odds ratio(OR)and 95%confidence interval(95%CI)were 2.289(1.091-4.804),5.842(1.658-20.587),2.634(1.095-6.333),7.138(3.255-15.655),2.751(1.271-5.953),3.153(1.477-6.733),all P＜0.05].ROC curve analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support all had certain predictive value for the occurrence of PTSD in ischemic stroke patients,the area under the ROC curve(AUC)was 0.602,0.675,0.573,0.722,0.603,0.624,and 95%CI was 1.091-4.804,1.342-9.566,1.095-6.333,3.255-15.655,1.271-5.953,1.477-6.733,respectively,all P＜0.05.The sensitivity to predict PTSD in ischemic stroke patients was 58.2%,87.7%,87.7%,79.5%,80.1%,78.8%,and the specificity was 37.8%,67.6%,70.3%,35.1%,59.5%,54.1%,respectively.Conclusions Ischemic stroke patients have a certain risk of concurrent stress disorder after trauma,and are easily affected by stroke patients'personality characteristics,daily living ability,swallowing dysfunction,coping style and social support,etc.Targeted preventive interventions should be developed to reduce the risk of PTSD and improve the prognosis and quality of life.