支气管镜检查在儿童大叶性肺炎的临床应用

Bronchoscopy in the clinical application of lobar pneumonia in children

目的 探讨儿童大叶性肺炎的临床特点和支气管镜诊治效果。方法 选择 2012 年 1 月至 2014 年 12 月广州医科大学附属第一医院儿科住院的 210 例大叶性肺炎患儿,其中支气管镜组 122例,内科治疗组 88 例。对其临床表现、病原学检查等资料进行统计学分析。内科治疗组给予抗感染、化痰等药物进行治疗,支气管镜组则在内科治疗的基础上采用支气管镜肺泡灌洗术进行介入治疗。密切观察患儿的住院的天数、发热缓解的时间、咳嗽缓解的时间、肺部啰音消失的时间等。结果 支气管镜组患儿的住院天数、发热缓解时间、咳嗽缓解时间、肺部啰音消失时间均少于内科治疗组,差异均有统计学意义 （ P ±0.05 ）,两组在治疗前后 2 周复查的影像学均有不同程度吸收,差异无统计学意义。但其中重症肺炎患儿经支气管镜行支气管肺泡灌洗术治疗后,其发热缓解时间、临床体征改善时间、住院天数以及治疗前后 2 周复查的影像学吸收改善情况则显著优于重症内科治疗组,差异有统计学意义 （ P ±0.05 ）。结论 大叶性肺炎患儿在内科治疗基础上经支气管镜介入治疗,能够促进病情恢复,尤其在重症大叶性肺炎。

Objective To investigate the clinical characteristics of children lobar pneumonia and bronchoscopic diagnosis and treatment effect. Methods 210 cases of pediatric hospitalization in children with lobar pneumonia, which bronchoscopy group 122 cases, 88 cases of medical, treatment group were selected from the First Affiliated Hospital of Guangzhou Medical University, January 2012 to December 2014. Statistical analysis of its clinical manifestations, etiology inspection data. Medical treatment group were given anti infective, and phlegm and other drugs for treatment, bronchoscopy in the group on the basis of medical treatment using bronchoscopy lavage interventional treatment. Close observation of the number of days of hospitalization of children with fever of remission, remission time cough, pulmonary rales disappeared time. Results Days of hospitalization, fever and cough relief time and pulmonary rales disappeared time in bronchoseopy group were significantly shorter than those in medical treatment group （ P 〈 0.05）, while there was no significant difference in radiological manifestation between two groups （ P 〉0.05）. All the above observations were significantly improved in patients with severe pneumonia undergoing optimal medical therapy with bronehoalveolar l.avage compared with those treated without bronehoalveolar lavage （ P 〈 0.05）. Conclusions The lobar pneumonia in children with medical treatment based on bronchoscopie intervention, can promote disease recovery, especially in severe lobar pneumonia.