糜蛋白酶联合肺泡灌洗治疗儿童重症肺炎的疗效

Clinical efficacy of chymotrypsin combined with bronchoscopic alveolar lavage in treatment of severe pneumonia in children

目的 探讨糜蛋白酶局部注入联合支气管镜肺泡灌洗治疗儿童重症肺炎的临床效果及对免疫功能的影响。方法 选取2018年1月至2021年1月在陕西省核工业二一五医院接受诊治的80例重症肺炎患儿为研究对象,根据随机数字表法分为治疗组(n=40)和对照组(n=40)。比较两组患儿治疗前后的血清炎性因子水平及患儿肺部X线改善时间、肺部啰音消失时间、住院时间、临床治疗有效率及不良反应的发生情况。结果 治疗组的肺部X线改善时间、肺部啰音消失时间和住院时间均显著少于对照组(t值分别为2.421、2.423、1.865,P<0.05);治疗后,治疗组的干扰素(IFN)-γ、Th1/Th2均显著低于对照组(t值分别为2.011、2.125,P<0.05);治疗组的有效率明显高于对照组(χ^(2)=4.021,P<0.05);两组的不良反应发生率差异无统计学意义(P>0.05)。结论 糜蛋白酶局部注入联合支气管镜肺泡灌洗治疗儿童重症肺炎的临床效果明显,可有效控制炎症反应,维持免疫系统的稳定,促进患儿恢复,具有较高的临床价值。

Objective To investigate clinical therapeutic effect of local injection of chymotrypsin combined with bronchoscopic alveolar lavage in treatment of severe pneumonia in children and its influence on immune function of the children.Methods 80 children with severe pneumonia who were diagnosed and treated in our hospital from January 2018 to January 2021 were selected as research subjects, and were divided into control group(n=40) and treatment group(n=40) in random number table method.2-3 mL of fasting venous blood sample was taken and T lymphocyte subsets were detected, 3 mL of fasting cubital venous blood sample was taken and serum levels of IFN-γ and IL-4 were detected by using ELISA before and after treatment.Serum levels of inflammatory factors, lung X-ray performance improvement time, vesicular rales disappearance time and hospitalization length, clinical effective rate and incidence of adverse reactions such as nausea and vomiting, bronchial mucosal hemorrhage, transient hypoxemia of the children were observed and compared between the two groups before and after treatment.Results The lung X-ray performance improvement time, the vesicular rales disappearance time, and the length of hospital stay in the treatment group were significantly shorter than those in the control group, and the differences were statistically significant(t=2.421,2.423 and 1.865 respectively, all P<0.05).After treatment, the serum levels of IFN-γ and Th1/Th2 of the children in the treatment group were lower than those in the control group(t=2.011 and 2.125 respectively, both P<0.05).The effective rate in the treatment group was higher than that in the control group, and the difference was significant(χ^(2)=4.021,P<0.05).In incidences of adverse reactions, there were no significant differences between the two groups(χ^(2)=0.157,all P>0.05).Conclusion Local injection of chymotrypsin combined with bronchoscopic alveolar lavage exerts obvious clinical therapeutic effects for severe pneumonia in children.It can effectively control inflammatory response, correct Th1/Th2 imbalance, maintain stability of the immune system, and promote recovery of the children.It is safe and feasible, so it is of high clinical application value.