支气管镜下刷检对儿童难治性肺炎支原体肺炎的临床价值探讨

Clinical value of bronchoscopic brushing in the treatment of children with refractory mycoplasma pneumoniae pneumonia

目的探讨支气管镜下刷检在儿童难治性肺炎支原体肺炎(RMPP)治疗方面的应用价值。方法回顾性分析2009年5月至2018年2月因RMPP收住首都医科大学附属北京友谊医院并行支气管镜检查的52例患儿资料,根据CT检查结果将患儿分为肺不张组(15例)及肺部实变组(37例),再根据所行电子支气管镜下操作不同分为支气管镜下支气管肺泡灌洗(BAL)治疗组及支气管镜下BAL联合刷检治疗组,肺不张组患儿中4例行单纯BAL治疗,11例行BAL联合刷检治疗;肺部实变组患儿中20例行单纯BAL治疗,17例行BAL联合刷检治疗。分别比较单纯BAL治疗和BAL联合刷检治疗对肺不张和肺部实变患儿的临床价值。结果肺不张组患儿,对比2周内肺部炎症吸收情况,BAL联合刷检治疗组优于单纯BAL治疗组[81. 9%(9/11)比25%(1/4),χ~2=4. 261,P=0. 039]。肺部实变组患儿,BAL联合刷检治疗组1周内肺部炎症吸收情况优于单纯BAL治疗组[58. 8%(10/17)比20%(4/20),χ~2=6. 514,P=0. 039]。结论对于儿童RMPP,特别是伴有炎症性肺不张的患儿,早期行支气管镜下刷检治疗,能够缩短病程,减少后遗症的发生,改善预后。

Objective To discuss the clinical value of bronchoscopic brushing in the treatment of children with refractory mycoplasma pneumoniae pneumonia （RMPP）. Methods 52 RMPP inpatients with bronchoscopy results in Beijing Friendship Hospital from May 2009 to February 2018 were divided into two groups retrospectively, namely the atelectasis group （n=15） and the pulmonary consolidation group （n=37）. The two groups were subdivided into bronchoalveolar lavage （BAL） group （4 of atelectasis and 20 of pulmonary consolidation） and BAL combining brushing group （11 of atelectasis and 17 of pulmonary consolidation）. The efficacy of the two operations were evaluated and compared. Results For atelectasis group, the inflammatory absorption occurred more in BAL combining brushing children than in BAL alone children two weeks posttreatment [81.9% （9/11） vs. 25% （1/4）, χ 2=4.261, P =0.039]. For pulmonary consolidation group, the inflammatory absorption occurred more in BAL combining brushing children than in BAL alone children a week posttreatment [58.8% （10/17） vs. 20% （4/20）, χ 2=6.514, P =0.039]. Conclusion For RMPP children, especially those with atelectasis, early bronchoscopic brushing can be essential for better prognosis.