纤维支气管镜在儿童异基因造血干细胞移植术后合并重症肺炎中的治疗价值

Value of fiberoptic bronchoscopy in the treatment of severe pneumonia in children after allogeneic hematopoietic stem cell transplantation

目的探讨纤维支气管镜(纤支镜)在救治儿童异基因造血干细胞移植(allo-HSCT)术后并发重症肺炎治疗中的治疗价值。方法回顾分析中国科学技术大学附属第一医院(安徽省立医院)儿童重症监护室(PICU)2017年1月至2021年1月allo-HSCT术后并发重症肺炎的22例患儿采用机械通气、纤支镜支气管肺泡灌洗术(BAL)、肺泡灌洗液(BALF)培养及病原微生物DNA高通量宏基因测序(二代测序)等治疗,观察治疗前后动脉血气分析结果变化、炎症因子(降钙素原、C反应蛋白及白细胞介素-6)水平变化及灌洗液二代测序病原学检测结果分析。结果BALF二代测序的有致病意义病原体阳性检出率为90.7%(39/43);治疗后患儿动脉血气分析中,氧分压及氧合指数水平均较治疗前明显改善(P<0.05)、二氧化碳分压水平较治疗前显著下降(P<0.01),治疗后血清降钙素原、C反应蛋白及白细胞介素-6水平均较治疗前明显下降(P均<0.05)。结论将纤支镜治疗用于儿童allo-HSCT术后合并重症肺炎的治疗中,可快速改善动脉血气指标、降低炎症因子水平、提升病原体检出率并指导抗感染治疗方向,有利于缩短病程并促进患儿康复。

Objective To explore the therapeutic value of bronchofibroscope in the treatment of severe pneumonia after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in children.Methods 22 children complicated with severe pneumonia after allo-HSCT who underwent mechanical ventilation,bronchoalveolar lavage(BAL),bronchoalveolar lavage fluid(BALF)culture,and high-throughput metagenomic sequencing(Next-generation sequencing)in the Pediatric Intensive Care Unit(PICU)of the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2017 to January 2021 were analyzed retrospectively.The changes in arterial blood gas analysis,the inflammatory factors(procalcitonin,C-reactive protein,and interleukin-6)levels and the analysis of pathogen detection results of the Next-generation sequencing of lavage fluid were observed before and after treatment.Results The positive detection rate of pathogenic pathogens by BALF Next-generation sequencing reached 90.7%(39/43).After treatment,the oxygen partial pressure and oxygenation index levels in the arterial blood gas analysis of the children were significantly improved compared with those before treatment(P<0.05),and the carbon dioxide partial pressure level was significantly decreased compared with those before treatment(P<0.01),and the serum procalcitonin,C-reactive protein,and interleukin-6 levels were significantly decreased after treatment compared with those before treatment(P<0.05).Conclusion The application of bronchofibroscope in the treatment of children with severe pneumonia after allo-HSCT can quickly improve arterial blood gas indicators,reduce the level of inflammatory factors,increase the detection rate of pathogens and guide the direction of anti-infection treatment,which is conducive to shortening the course of the disease and promoting the rehabilitation of children.