床旁纤支镜肺泡灌洗在儿童机械通气重症肺炎中的应用

Application of bronchoalveolar lavage with bedside fiberoptic bronchoscopy for severe pneumonia in children with mechanical ventilation

目的:探讨纤支镜肺泡灌洗辅助治疗儿童机械通气重症肺炎的临床疗效及安全性。方法:收治机械通气重症肺炎患儿90例,随机分为观察组和对照组。对照组采用常规治疗+常规吸痰,观察组在常规治疗基础上在床旁行纤支镜肺泡灌洗,比较两组治疗效果。结果:①呼吸功能:治疗后,观察组PaO_2/FiO_2高于对照组,心率、呼吸及PaCO_2低于对照组(P<0.05);②疗效及预后指标:观察组治疗总有效率高于对照组,机械通气时间及重症监护时间均短于对照组(P<0.05)。③不良反应:观察组发生氧饱和度下降、发热、支气管痉挛及支气管黏膜出血等不良反应,经对症处理均能缓解。④病原菌培养:肺泡灌洗液培养阳性率高于常规吸痰组。结论:床旁纤支镜肺泡灌洗治疗儿童机械通气重症肺炎,能有效改善呼吸功能,缩短有创通气时间和重症监护时间,提高病原菌培养阳性率,安全、有效。

Objective:To explore the clinical efficacy and safety of bronchoalveolar lavage with bedside fiberoptic bronchoscopy for adjuvant therapy of severe pneumonia in children with mechanical ventilation.Methods:90cases of children with severe pneumonia and mechanical ventilation were selected.They were randomly divided into the observation group and the control group.The control group was treated with conventional treatment plus routine sputum suction,and the observation group added bronchoalveolar lavage with bedside fiberoptic bronchoscopy based on the conventional treatment.We compared the treatment effect of two groups.Results:①Respiratory function:After treatment,in the observation group,the PaO2/FiO2was higher than the control group,and the heart rate,respiratory rate and PaCO2were lower than the control group(P<0.05).②Curative effect and prognostic index:In the observation group,the effective rate of treatment was higher than the control group,and the time of mechanical ventilation and intensive care were shorter than the control group(P<0.05).③Adverse reaction:There were decreased oxygen saturation,fever,bronchospasm and bronchial mucosal bleeding and so on.After symptomatic treatment,the adverse reactions were alleviated.④Pathogen culture:The positive rate of alveolar lavage fluid was higher than that of the routine sputum aspiration group.Conclusion:The application of bronchoalveolar lavage with bedside fiberoptic bronchoscopy for adjuvant therapy of severe pneumonia in children with mechanical ventilation can effectively improve the respiratory function,shorten the time of invasive ventilation and the time of intensive care,and improve the positive rate of pathogens culture,and it was safe and effective.