支气管镜灌洗术在儿童重症腺病毒肺炎的应用

Application of bronchoscopic lavage in children with severe adenovirus pneumonia

目的:探讨支气管镜灌洗术在重症腺病毒肺炎患儿的疗效和安全性。方法:回顾性分析2019年2月至6月入住湖南省儿童医院重症监护室行支气管镜检查的51例重症腺病毒肺炎患儿的临床资料,根据是否灌洗分为灌洗组36例和未灌洗组15例。记录支气管镜诊断结果,支气管镜治疗前及治疗后2 h、24 h、48 h的血气分析,临床症状(发热、肺部湿啰音)改善时间、病原检出阳性率、病死率,治疗前及治疗后1 h、2 h、24 h的主要生命体征如心率、呼吸频率、平均动脉压,以及支气管镜检查相关并发症。结果:51例患儿均有支气管内膜炎,灌洗组36例气道内可见较多分泌物,未灌洗组15例仅有少许或无分泌物;灌洗组治疗后2 h、24 h、48 h的P/F值、PCO 2较治疗前均有改善,且优于未灌洗组( P<0.05),未灌洗组治疗后24 h、48 h的P/F值上升,PCO 2治疗后48 h下降( P<0.05)。灌洗组热程、肺部湿啰音消退时间均短于未灌洗组( P<0.05);灌洗组病死率低于未灌洗组[2.8%(1/36)比26.7%(4/15), P<0.05],灌洗组病原检出阳性率高于未灌洗组[55.6%(20/36)比20.0%(3/15), P<0.05]。支气管镜治疗前后各时间点的心率、呼吸频率、平均动脉压比较差异无统计学意义( P>0.05)。相关并发症分别为术中一过性低氧血症11例、支气管黏膜出血4例,术后低氧血症、术中高血压、低血压各1例,两组并发症发生率差异无统计学意义( P>0.05)。 结论:重症腺病毒肺炎患儿应用支气管镜灌洗术,可能改善临床症状、呼吸功能,提高病原检出阳性率,降低病死率,安全有效。

Objective To investigate the efficacy and safety of bronchoscopic lavage in children with severe adenoviral pneumonia.Methods Patients with severe adenovirus pneumonia who were admitted to ICU department of Hunan Children′s Hospital for bronchoscopy were collected from February to June 2019 and divided into lavage group(n=36)and non-lavage group(n=15)in line with whether lavage was performed.Their results,namely,bronchoscopic diagnosis,blood gas analysis before and 2 hours,24 hours and 48 hours after bronchoscopy,improvement time of clinical symptoms(fever and pulmonary moist rales),the positive rate of pathogen detection and mortality rate,main vital signs such as heart rate,respiratory rate,mean arterial pressure and bronchoscopy-related complications were recorded before and 1 hour,2 hours and 24 hours after bronchoscopy.Results A total of 51 children were collected,all of whom suffered from endobronchitis.More secretions were observed in the airways of 36 patients in the lavage group,and only a little or no secretions were observed in 15 patients in the non-lavage group.P/F value and PCO2 at 2 hours,24 hours and 48 hours after treatment in the lavage group were improved comparing to those before treatment and were superior to those in the non-lavage group(P<0.05).P/F values at 24 hours and 48 hours after treatment in the non-lavage group increased and PCO2 decreased at 48 hours after treatment(P<0.05).The thermal duration,time to resolution of moist rales in the lungs in the lavage group were shorter than those in the non-lavage group(P<0.05).The mortality rate in the lavage group was lower than that in the non-lavage group[2.8%(1/36)vs.26.7%(4/15),P<0.05].The positive rate of pathogen detection in lavage group was higher than that in non-lavage group[55.6%(20/36)vs.20.0%(3/15),P<0.05].There was no significant difference in heart rate,respiratory rate,and mean arterial pressure at each time point before and after bronchoscopic treatment(P>0.05).Associated complications were 11 cases of intraoperative transient hypoxemia,four cases of bronchial mucosal bleeding,and one case each of postoperative hypoxemia,intraoperative hypertension and hypotension.There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Bronchoscopic lavage,in treating children with severe adenovirus pneumonia,may improve clinical symptoms,respiratory function,and rate of pathogen detection,reduce mortality,and is effective and safe.