经纤维支气管镜灌洗联合乙酰半胱氨酸治疗重症肺炎患儿的效果及对细胞间黏附分子1和肾上腺髓质素水平的影响

Effect of bronchofiberscope lavage combined with acetylcysteine on children with severe pneumonia and its influence on intercellular adhesion molecule-1 and adrenomedullin levels

目的探讨经纤维支气管镜灌洗联合乙酰半胱氨酸治疗重症肺炎患儿的效果及对细胞间黏附分子1(ICAM-1)、肾上腺髓质素(ADM)水平的影响。方法选取2018年4月至2020年1月河北省秦皇岛市第一医院收治的100例重症肺炎患儿。根据便利抽样法将100例患儿分为对照组和观察组,各50例。对照组采用抗感染及经纤维支气管镜灌洗治疗,观察组采用抗感染、经纤维支气管镜灌洗联合乙酰半胱氨酸治疗。比较2组临床疗效,肺换气功能相关指标,血清ICAM-1、ADM水平及并发症发生率。结果观察组总有效率高于对照组[94.0%(47/50)比72.0%(36/50)],差异有统计学意义(χ^(2)=21.186,P=0.001)。观察组术后动脉血氧饱和度、动脉血氧分压、氧合指数水平均明显高于对照组,血清ICAM-1、ADM水平均明显低于对照组[(87±6)%比(79±5)%、(83±6)mmHg(1 mmHg=0.133 kPa)比(72±5)mmHg、(368±25)mmHg比(314±20)mmHg、(3.3±0.9)μg/L比(5.6±1.4)μg/L、(48±10)ng/L比(56±10)ng/L],差异均有统计学意义(均P<0.05)。2组术后并发症发生率差异无统计学意义(χ^(2)=0.189,P=0.395)。结论经纤维支气管镜灌洗联合乙酰半胱氨酸可有效缓解重症肺炎患儿的临床症状及体征,改善肺换气功能相关指标,降低血清ICAM-1、ADM水平。

Objective To investigate the effect of bronchofiberscope lavage combined with acetylcysteine on children with severe pneumonia and its influence on intercellular adhesion molecule-1(ICAM-1)and adrenomedullin(ADM)levels.Methods From April 2018 to January 2020,100 children with severe pneumonia admitted to First Hospital of Qinhuangdao,Hebei Province were enrolled.According to the convenient sampling method,100 children were divided into control group and observation group,with 50 cases in each group.The control group was treated with anti infection and bronchofiberscope lavage,and the observation group was treated with anti infection,bronchofiberscope lavage and acetylcysteine.The clinical efficacy,related indexes of pulmonary ventilation function,levels of serum ICAM-1 and ADM,and the incidence of complications were compared between the two groups.Results The total effective rate of observation group was higher than that of control group[94.0%(47/50)vs 72.0%(36/50)](χ^(2)=21.186,P=0.001).The levels of arterial oxygen saturation,arterial oxygen partial pressure and oxygenation index of observation group were significantly higher than those of control group,and the levels of serum ICAM-1 and ADM of observation group were significantly lower than those of control group[(87±6)%vs(79±5)%,(83±6)mm Hg vs(72±5)mm Hg,(368±25)mm Hg vs(314±20)mm Hg,(3.3±0.9)μg/L vs(5.6±1.4)μg/L,(48±10)ng/L vs(56±10)ng/L](all P<0.05).There was no significant difference in the incidence of complications between the two groups(χ^(2)=0.189,P=0.395).Conclusion Bronchofiberscope lavage combined with acetylcysteine can effectively relieve the clinical symptoms and signs of children with severe pneumonia,improve related indexes of pulmonary ventilation function,and reduce serum ICAM-1 and ADM levels.