纤维气管镜介入治疗儿童重症肺炎支原体肺炎的疗效分析

Efficacy of fiberoptic bronchoscopy intervention in the treatment of severe pneumonia mycoplasma pneumonia in children

目的探讨纤维支气管镜介入治疗儿童重症肺炎支原体肺炎的疗效。方法回顾性分析2015年6月~2016年6月收住泉州市儿童医院呼吸科病房,诊断为重症肺炎支原体肺炎(severe mycoplasma pneumoniae pneumonia,SMPP)的患儿83例。在有效抗感染、化痰、抗炎等治疗的基础上,根据是否行纤维支气管镜介入治疗分为治疗组45例和对照组38例,比较两组的体温正常时间、咳嗽缓解时间、肺部啰音消退时间、住院时间、疗效及后遗症发病率。结果治疗组体温正常时间、咳嗽缓解时间、肺部啰音消退时间、住院时间明显缩短,治愈率及总有效率明显高于对照组,后遗症发病率少(P<0.05)。治疗组治愈率为77.78%,明显高于对照组(44.74%),差异有统计学意义(P<0.05)。治疗组支气管镜下均表现为气管、支气管黏膜充血、肿胀,管腔内黏稠分泌物增多,甚至塑形性痰栓阻塞支气管开口,部分病例可见滤泡样增生,纵行皱褶,管壁增厚,部分患儿气道黏膜可见溃疡、糜烂面,甚至管腔狭窄。结论纤维支气管镜介入治疗可较早改善SMPP临床症状、缩短住院时间、提高疗效,减少后遗症的发生。

Objective To investigate the effect of fiberoptic bronchoscopy interventional treatment on severe pneumoni- a in children with mycoplasma pneumonia. Methods 83 children with the diagnosis of severe mycoplasma pneumoniae pneumonia （SMPP） admitted in respiratory department ward of Quanzhou Children＇s Hospital from June 2015 to June 2016 were retrospectively analyzed.On the basis of effective anti-infection, phlegm, anti-inflammatory treatment, the patients were divided into treatment group of 45 cases and the control group of 38 cases, according to whether the intervention of fiberoptic bronchoscopy. The body temperature returned to normal time, cough remission time, pulmonary rales fade time, hospitaI stay, efficacy and sequelae morbidity between the two groups were compared. Results The body temperature returned to normal time, cough remission time, lung rales subsided time and hospitalization time were significantly shortened in the treatment group. The cure rate and total effective rate were significantly higher in the treatment group than those in the control group, and incidence of sequelae was less in the treatment group（P〈O.05）. The cure rate was 77.78% in the treatment group, which was significantly higher than that in the control group（44.74%）, and the difference was statistically significant（P〈0.05）. Treatment group bronchoscopy showed tracheal, bronchial mucosa congestion and swelling, lacunar viscous secretions increasing and even obstruction of bronchial opening by shaped phlegm. Follicular hyperplasia, longitudinal wrinkles, wall thickening can be seen in some cases. Ulcers, erosion surface and even stenosis can be seen in airway mucosa of some children. Conclusion Interventional treatment of fiberoptic bronchoscopy can early improve the clinical symptoms of SMPP, and shorten the hospitalization time, which improve the curative effect and reduce the occurrence of sequelae.