纤维支气管镜在儿童重症肺炎治疗中的应用

Application of fiberoptic bronchoscopy in the treatment of severe pneumonia in children

目的探讨纤维支气管镜在儿童重症肺炎治疗中的应用效果。方法将68例重症肺炎患儿按照随机数字表法分为研究组与对照组,各34例。两组均给予化痰、吸氧和补液等对症支持治疗和常规护理,研究组在此基础上给予纤维支气管镜进行干预,观察14 d。比较两组临床疗效、症状缓解时间、机械通气时间及儿童重症监护室住院时间;比较治疗前后两组患儿血氧分压、动脉血二氧化碳分压及氧合指数水平;采集两组呼吸道分泌物进行痰培养,计算痰菌转阴率,比较两组血清降钙素原、C反应蛋白及白细胞介素-6水平。结果两组临床疗效比较差异无统计学意义(P>0.05),研究组症状缓解时间、机械通气时间、儿童重症监护室住院时间均显著短于对照组(P<0.05或0.01)。治疗后两组血氧分压及氧合指数水平均较治疗前显著升高(P<0.01),动脉血二氧化碳分压水平较治疗前显著下降(P<0.01),研究组血氧分压及氧合指数水平较对照组升高更显著(P<0.05)。治疗后研究组痰菌转阴率显著高于对照组(P<0.05)。治疗后两组血清降钙素原、C反应蛋白及白细胞介素-6水平水平均较治疗前显著下降(P<0.01),研究组较对照组下降更显著(P<0.05)。结论将纤维支气管镜用于儿童重症肺炎的治疗中,可快速缓解症状,改善动脉血气指标,提升痰菌转阴率,降低炎症因子水平,有利于缩短病程并促进患儿康复。

Objective To study the application effects of fiberoptic bronchoscopy in the treatment of severe pneumonia in children.Methods A total of 68 children patients with severe pneumonia were divided into the observation group and the control group,with 34 cases in each group.They were given symptomatic supportive treatments such as phlegm reduction,oxygen uptake and fluid replacement and routine nursing.The observation group was given fiberoptic bronchoscopy for intervention on this basis,and the two groups were treated for 14 d.Compare the clinical efficacy of the two groups.The time of symptom relief after treatment,the time of mechanical ventilation and the length of stay in the pediatric intensive care unit were compared between the two groups.Compare the partial pressure of oxygen(PaO 2),partial pressure of carbon dioxide in artery(PaCO 2)and oxygenation index levels between the two groups before and after treatment.Collect the respiratory secretions of the two groups and conduct sputum culture to calculate the negative rate of sputum bacteria.The levels of serum procalcitonin(PCT),C-reactive protein(CRP)and interleukin-6(IL-6)were compared between the two groups.Results After treatment,PaO 2 and oxygenation index levels in the two groups were significantly higher than before treatment(P<0.01),PaCO 2 levels were significantly lower than before treatment(P<0.01),the PaO 2 and oxygenation index levels of the study group increased more significantly than those of the control group(P<0.05).After treatment,the negative rate of sputum bacteria in the study group was significantly higher than that in the control group(P<0.05).After treatment,the levels of serum PCT,CRP and IL-6 in the two groups were significantly lower than before treatment(P<0.01),and the decrease in the study group was more significant than that in the control group(P<0.05).Conclusions Fiberoptic bronchoscopy for severe pneumonia in children can quickly relieve symptoms,improve arterial blood gas indexes,increase sputum bacterium negative conversion rate and reduce the level of inflammatory factors,and it is beneficial to shorten the course of the disease and promote the recovery of children.