发热期重症肺炎患儿纤维支气管镜灌洗治疗效果分析

Clinical Efficacy of Bronchoscopy Lavage Treatment for Children with Severe Pneumonia in Fever Stage

目的评估纤维支气管镜灌洗治疗发热期重症患儿临床疗效。方法选取于2014年1月至2015年1月射洪县人民医院收治的发热期重症肺炎患儿184例。按随机数字表法将患儿分为观察组和对照组,各92例,观察组在常规治疗基础上给予纤维支气管镜灌洗治疗,对照组采用常规治疗,比较两组患儿症状体征及疗效。结果观察组患者纤维支气管镜下表现为急性或慢性的气管支气管内膜炎,经纤维支气管镜灌洗后76例(83.5%)出现白色至黄色的分泌物,65例(71.4%)黏膜苍白,26例(28.65)黏膜充血,41例(45.1%)气道呈高反应性,11例(12.1%)纵行皱襞,12例(13.2%)气管支气管;治疗后患者的体温、痰量、白细胞计数、肺啰音等均较治疗前显著降低(P<0.05),但观察组低于对照组[(36.4±1.2)℃比(37.5±1.6)℃,(8.5±2.2)m L/d比(17.5±2.3)m L/d,(7.1±2.1)×109/L比(9.8±2.1)×109/L,(1.2±0.2)d比(1.9±0.3)d](P<0.01);治疗后,观察组动脉血氧分压(PaO_2)、血氧饱和度(SO_2)显著高于对照组[(71.2±3.4)mmHg(1 mmHg=0.133 k Pa)比(64.3±3.4)mmHg,(96.4±5.6)%比(94.5±5.6)%],肺炎严重度指数(PSI)评分和急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分均显著低于对照组[(60.4±2.1)分比(85.3±6.7)分,(11.2±2.3)分比(17.8±4.5)分],差异有统计学意义(P<0.05);观察组总有效率显著高于对照组[97.8%(90/92)比66.3%(61/92)],差异有统计学意义(P<0.05)。结论使用纤维支气管镜灌洗治疗发热期重症肺炎患儿,缩短症状缓解时间及住院时间,降低经济成本,治疗疗效显著。

Objective To evaluate the clinical efficacy of brenchoscopic lavage treatment of children with severe fever. Methods Total of 184 children with severe pneumonia in fever stage hospitalized in Shehang County People＇s Hospital from Jan. 2014 to Jan. 2015 were included in the study and divided into an observation group （based on the conventional treatment given bronchoscopy lavage） and a control group （ conventional therapy） according to the random number table method,92 cases each. The signs and symptoms and therapeutic efficacy of the two groups were compared. Results The expression under bronchoseopy of patients in the observation group was acute or chronic meningitis within the tracheobronchial, after brenchoscopy lavage 76 cases（83.5% ） had white to yellow secretions, 65 cases（71.4% ） had pale mucous membranes, 26 cases （28.65） had mucosal congestion,41 cases （45. 1% ） showed high airway reactivity, 11 cases（ 12. 1% ） had longitudinal folds, 12 cases （ 13. 2% ） of tracheohronchitis; body temperature, sputum volume,white blood cell count, pulmonary rales and other symptoms and signs improved significantly （P 〈 0. 05） after treatment, but the observation group were lower than the control group[ （ 36. 4 ± 1.2 ） ℃ vs （37.5 ±1.6） ℃,（8.5 ±2.2） mL/d vs （17.5 ±2.3） mL/d,（7. 1±2. 1） ×10^9/L vs （9：8 ±2. 1） × 10^9/L, （ 1.2 ±0. 2） d vs （ 1.9 ±0.3 ） d] （P 〈0. 01 ） ;after treatment,PaO2, SO2 of the observation group were higher than the control group [ （ 71.2 ± 3.4 ） mmHg vs （ 64.3 ±3.4 ） mmHg, （96. 4 ± 5.6 ） % vs （94. 5 ± 5. 6） % ], PSI score and APACHE n score were lower than the control group [ （60. 4 ± 2. 1 ） scores vs （85. 3 ±6. 7） scores, （ 11. 2 ± 2.3 ） scores vs （ 17.8 ± 4. 5 ） scores ], the differences were statistically significant （P 〈 0. 05 ）. The total effective rate of the observation group was significantly higher than the cantrol group[ 97. 8% （ 90/92 ） vs 66. 3 % （61/92） ], the difference was statistically signifiean （ P 〈 0, 05 ）, Conclusion The use of brenchoscopic lavage treatment of children with severe pneumonia in fever, can shorten the symptoms relief time and reduce the hospitalization time and economic costs, with significant treatment effect.