重症肺炎合并呼吸衰竭患儿的病原学特征及支气管镜肺泡灌洗术的疗效分析

Analysis on the etiological characteristics and therapeutic effect of bronchoscopic alveolar lavage in children with severe pneumonia complicated with respiratory failure

目的分析重症肺炎合并呼吸衰竭(Severe pneumonia complicated with respiratory failure,SP-ARF)患儿的病原学特征及经支气管镜肺泡灌洗术的疗效,为有效制订临床救治方案提供研究依据。方法选取安徽省儿童医院2018年1月-2019年1月收治的102例SP-ARF患儿作为研究对象,根据患儿入院登记号将其分为研究组和对照组,每组各51例。对照组患儿给予常规对症治疗和抗感染治疗,研究组患儿在对照组患儿疗法的基础上联合应用经支气管镜肺泡灌洗术进行治疗。采集所有患儿的血样本,对其中细菌、真菌、病毒、肺炎支原体(Mycoplasma pneumoniae,MP)等病原体特征进行检测和分析。对两组患儿的疗效指标及治疗前、治疗72 h时的动脉血气指标进行观察和比较。结果有30例患儿的血标本中检出细菌或真菌,检出病原菌30株,其中,革兰阴性菌23株占76.67%,以肺炎克雷伯菌、嗜麦芽窄食单胞菌、大肠埃希菌为主;革兰阳性菌4株占13.33%,以金黄色葡萄球菌为主;真菌3株占10.00%,以白假丝酵母为主。有36例患儿的血清病毒IgM呈阳性,检出病毒以呼吸道合胞病毒、柯萨奇病毒、巨细胞病毒为主。有11例患儿的血清MP-IgM呈阳性,检出率为10.78%。研究组患儿的发绀消失时间、呼吸困难消失时间、肺部啰音消失时间、心率恢复正常时间、住院时间均优于对照组,在治疗72 h时,研究组患儿的动脉血气指标改善幅度均优于对照组,差异均有统计学意义(P<0.05)。结论细菌、病毒和MP是SP-ARF患儿血标本中的主要病原体,较多的患儿表现为多种病原体的混合感染,于疾病早期经支气管镜给予肺泡灌洗术治疗,可提高疗效、快速改善血气指标,有利于改善患儿的预后。

OBJECTIVE To analyze the etiological characteristics and the therapeutic effects of bronchoscopic alveolar lavage in children with severe pneumonia complicated with respiratory failure(SP-ARF), so as to provide research basis for the effective formulation of clinical treatment programs. METHODS A total of 102 children with SP-ARF treated in the Anhui Children’s hospital from Jan. of 2018 to Jan. of 2019 were selected as the research objects and were divided into the study group and the control group according to their admission registration number, with 51 cases in each group. The children in the control group were given conventional symptomatic therapy and the anti-infection treatments, while the children in the study group were treated with bronchoscopic alveolar lavage on the basis of the therapy in the control group. Blood samples were collected from all children, and the characteristics of the pathogens such as bacteria, fungi, viruses, Mycoplasma pneumoniae(MP)were detected and analyzed. The efficacy indicators and arterial blood gas indexes of the two groups of children before the treatments and 72 hours after treatments were observed and compared between the two groups of children. RESULTS 30 strains of bacteria or fungi were detected in the blood samples of 30 children, of which 23 strains of Gram-negative bacteria accounted for 76.67%, mainly Klebsiella pneumoniae, Stenotrophomonas maltophilia and Escherichia coli;4 strains of Gram-positive bacteria accounted for 13.33%, mainly Staphylococcus aureus, and 3 strains of fungi accounted for 10.00%, mainly Candida albicans. Serum virus IgM was positive in 36 children. Respiratory syncytial virus, Coxsackievirus and Cytomegalovirus were the major viruses detected. Serum MP-IgM was positive in 11 children with a detection rate of 10.78%. The time of disappearance of cyanosis, disappearance of dyspnea, disappearance of lung snoring sounds, the time of heart rate recovery, the length of hospital stay in the study group were better than those in the control group. At 72 hours of treatment, the improvement of the arterial blood gas indicators in the study group was significantly better than that in the control group(P<0.05). CONCLUSION Bacteria, viruses and MP were the main pathogens in the blood samples of the children with SP-ARF. Most children show mixed infections of multiple pathogens. Alveolar lavage treatment through bronchoscopy at the early stage of the disease could improve the curative effects and rapidly improve the blood gas indexes, which is benefit for the prognosis of children with SP-ARF.