纤维支气管镜下支气管肺泡灌洗治疗儿童重症支原体肺炎的疗效探讨

Clinical efficacy of fiber bronchoscopic bronchoalveolar lavage on treatment of children with severe mycoplasma pneumoniae pneumonia

目的探讨纤维支气管镜(简称:纤支镜)下支气管肺泡灌洗术及沐舒坦、布地奈德支气管注药联合常规抗生素治疗儿童重症支原体肺炎(MPP)的临床疗效。方法选取2012年11月至2014年12月收治的107例重症MPP患儿,随机分为常规治疗组51例和纤支镜组56例。常规组患儿给予大环内脂类药物治疗,并予以退热、止咳、祛痰等对症治疗,必要时使用激素与免疫球蛋白;纤支镜组在常规组基础上使用纤支镜进行生理盐水支气管肺泡灌洗,及病变部位沐舒坦、布地奈德注药治疗。治疗7d后,检测外周血炎性因子水平,判定临床疗效,比较两组症状体征消失时间。结果治疗7d后,纤支镜组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hs—CPR)水平均显著低于常规组(U值分别为3.185、2.886、3.882,均P<0.05)。纤支镜组平均体温恢复时间、咳嗽消失时间、啰音消失时间、肺部X线恢复时间及住院时间均明显少于常规组,差异均具有统计学意义(U值分别为4.681、4.624、5.517、4.111、3.681,均P<0.05)。治疗7d内,纤支镜组转为有创通气比例为3.6%,低于常规组的13.7%,差异具有统计学意义(Fisher P=0.083)。两组疗效构成无明显差异(Z=1.681,P=0.093);纤支镜组总体有效率为94.6%,明显高于常规组的82.4%,差异具有统计学意义(X^2=4.049,P=0.044)。结论大环内脂类药物联合纤支镜肺泡灌洗及沐舒坦、布地奈德支气管注药治疗小儿重症MPP,可明显减轻炎性反应,显著缩短患儿症状体征消失时间,提高临床疗效。

Objective To explore the clinical efficacy of bronchoalveolar lavage （ BAL ） , ambroxol and budesonide bronchial injection combining conventional antibiotics in treatment of children with severe mycoplasma pneumoniae pneumonia （ MPP ） .Methods From November 2012 to December 2014 107 severe MPP children were enrolled in study and were randomly divided into routine group （ 51 cases） and BAL group （56 cases）.The routine group was given macrolide drug treatment , and antipyretic, anti-cough and expectorant treatment was provided .Hormone and immunoglobulin protein were taken if necessary .Besides treatment for the routine group , BAL group was given BAL treatment , budesonide and ambroxol bronchial injection at lesions .After 7-day treatment peripheral blood inflammatory factors were examined and clinical efficacies were determined .Symptoms and signs disappearance time of two groups were compared . Results After 7-day treatment, peripheral blood TNF-α, IL-6 and hs-CRP levels in BAL group were significantly lower than the routine group （U value was 3.185, 2.886 and 3.882, respectively, all P〈0.05）.In BAL group average temperature recovery time , cough disappearance time , fading time of crackles , recovery of lung X-ray and hospitalization days were shorter with significant differences （ U value was 4.681, 4.624, 5.517, 4.111 and 3.681, respectively, all P〈0.05）.Within 7-day treatment, BAL group with invasive ventilation proportion （3.6%） was significantly lower than the routine group （13.7%） （fisher P=0.083）.Clinical efficacy constitutions of two groups were not different obviously （Z=1.681,P=0.093）.The overall efficiency of BAL group （94.6%） was significantly higher than the routine group （82.4%） （χ2 =4.049, P=0.044）.Conclusion Macrolides combining BAL treatment, ambroxol and budesonide bronchial injection can reduce inflammatory reaction , significantly shorten disappearance time of symptoms and signs and improve clinical efficacy on treatment of severe MPP .