电子支气管镜保留灌注乙酰半胱氨酸+布地奈德对难治性社区获得性肺炎患儿潮气呼吸肺功能、肺泡灌洗液IL-6、IFN-γ、MCP-1水平的影响

Effects of acetylcysteine and budesonide perfusion through electronic bronchoscope on tidal breathing lung function and levels of IL-6,IFN-γ and MCP-1 in bronchoalveolar lavage fluid of children with refractory community-acquired pneumonia

目的:探讨电子支气管镜保留灌注乙酰半胱氨酸和布地奈德对难治性社区获得性肺炎患儿潮气呼吸肺功能、肺泡灌洗液(BALF)白细胞介素-6(IL-6)、干扰素γ(IFN-γ)、单核细胞趋化蛋白-1(MCP-1)水平的影响。方法:选取石景山医院儿科在2017年10月~2020年10月收治的180例难治性社区获得性肺炎患儿,随机数表法分为两组各90例,对照组采用电子支气管镜灌洗治疗,试验组在采用电子支气管镜保留灌注乙酰半胱氨酸+布地奈德治疗,比较两组治疗有效率、治疗前后潮气呼吸肺功能、BALF中炎症指标水平、症状消失时间以及不良反应发生率。结果:本组180例患儿,试验组87例、对照组85例完成实验。治疗7d,试验组治疗有效率显著高于对照组。治疗7d,试验组潮气量(V_(T)/kg)、达峰时间比(TPTEF/TE)和达峰容积比(VPEF/VE)均显著高于对照组。治疗7d,试验组BALF中IL-6、IFN-γ和MCP-1水平显著低于对照组。试验组肺部啰音消失时间、退热时间和住院时间均显著低于对照组。二组治疗期间出现呼吸急促、阵发性咳嗽、低氧血症、紫绀及皮疹等不良反应发生率比较未见显著差异。结论:与电子支气管镜灌洗治疗相比,电子支气管镜保留灌注乙酰半胱氨酸和布地奈德治疗难治性社区获得性肺炎患儿,可显著降低其BALF中炎症因子水平,提升其潮气呼吸肺功能,缩短其症状消失和住院时间,疗效显著提升。

Objective To explore the effects of acetylcysteine and budesonide perfusion through electronic bronchoscope on tidal breathing lung function and levels of interleukin-6(IL-6),interferon-γ(IFN-γ)and monocyte chemoattractant protein-1(MCP-1)in bronchoalveolar lavage fluid(BALF)of children with refractory community-acquired pneumonia(CAP).Methods A total of 180 children with refractory CAP admitted to pediatrics department of Shijingshan Hospital from October 2017 to October 2020 were enrolled and divided into control group(electronic bronchoscope lavage)and experimental group(acetylcysteine and budesonide perfusion through electronic bronchoscope)by random number table method,90 cases in each group.The response rate of treatment,tidal breathing lung function before and after treatment,levels of inflammation indexes in BALF,disappearance time of symptoms and the incidence of adverse reactions were compared between the two groups.Results Of the 180 children,there were 87 cases in experimental group and 85 cases in control group completing the experiment.After 7d of treatment,the response rate of treatment in experimental group was significantly higher than that in control group.After 7d of treatment,tidal volume(V_(T)/kg),time to peak ratio(TPTEF/TE)volume to peak ratio(VPEF/VE)in experimental group were significantly higher than those in control group,while levels of IL-6,IFN-γand MCP-1 in BALF were significantly lower than those in control group.The disappearance time of lung rales,antipyretic time and hospitalization time in experimental group were significantly shorter than those in control group.There was no significant difference in the incidence of adverse reactions such as tachypnea,paroxysmal cough,hypoxemia,cyanosis and skin rash during treatment between the two groups.Conclusion Compared with electronic bronchoscope lavage,the application of acetylcysteine and budesonide perfusion through electronic bronchoscope in the treatment of children with refractory CAP can significantly reduce levels of inflammatory factors in BALF,enhance tidal breathing lung function,shorten disappearance time of symptoms and hospitalization time,with significant curative effect.