不同支气管镜支气管肺泡灌洗时机治疗难治性肺炎支原体肺炎患儿的临床效果

Clinical effects of different bronchoscopic bronchoalveolar lavage timings in children with refractory Mycoplasma pneumoniae pneumonia

目的对比不同支气管镜支气管肺泡灌洗时机对难治性肺炎支原体肺炎(RMPP)患儿的治疗效果。方法回顾性分析80例行支气管镜支气管肺泡灌洗治疗的RMPP患儿的临床资料。将接受肺泡灌洗治疗时病程<14 d的患儿设为早期组(n=39),病程≥14 d的患儿设为晚期组(n=41)。比较两组患儿的临床疗效、临床症状与体征改善时间,治疗前后肺功能、血清炎性因子水平,以及并发症发生情况。结果早期组的治疗效果优于晚期组,发热持续时间、咳嗽持续时间、啰音持续时间、住院时间均短于晚期组(均P<0.05)。早期组患儿治疗前、治疗7 d后的呼吸频率、吸呼气时间比降低幅度均大于晚期组,潮气量、达峰时间比的升高幅度均大于晚期组,血清白细胞介素-4、肿瘤坏死因子-α、C反应蛋白水平的降低幅度均大于晚期组(均P<0.05)。两组患儿的一过性发绀或缺氧、一过性心动过速、术后一过性剧烈咳嗽、术后低热、黏膜出血发生率比较,差异均无统计学意义(均P>0.05)。结论早期应用支气管镜支气管肺泡灌洗治疗RMPP患儿的效果优于晚期治疗,有利于炎性因子清除,改善肺功能,促进患儿症状与体征缓解,加快患儿病情康复。

Objective To compare the effects of different bronchoscopic bronchoalveolar lavage timings on children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods A retrospective analysis was performed on the clinical data of 80 children with RMPP who underwent bronchoscopic bronchoalveolar lavage.Children who received bronchoalveolar lavage with a course of less than 14 days were divided into the early group(n=39),and those who received bronchoalveolar lavage with a course of more than or equal to 14 days were divided into the late group(n=41).The clinical efficacy,improvement time of clinical symptoms and signs;lung function,serum inflammatory factor levels before and after treatment;and incidence of complications were compared between the two groups.Results The therapeutic effect of the early group was better than that of the late group,and the durations of fever,cough,and rale,and hospital stay were all shorter than those of the late group(all P<0.05).Before and after 7 days of the treatment,the respiratory frequency and inspiratory to expiratory ratio of the early group decreased more than those of the late group,the tidal volume and time to peak ratio increased more than those in the late group,and serum interleukin-4,tumor necrosis factor-αand C-reactive protein levels decreased more than those in the late group(all P<0.05).There were no statistically significant difference in the incidence of transient cyanosis or hypoxia,transient tachycardia,postoperative transient severe cough,postoperative low grade fever,or mucosal hemorrhage between the two groups(all P>0.05).Conclusion The early application of bronchoscopic bronchoalveolar lavage in the treatment of children with RMPP is better than its late treatment,which is conducive to the removal of inflammatory factors and can improve the lung function,promotes the alleviation of symptoms and signs in children,and accelerates the recovery of their condition.