支气管肺泡灌洗术联合免疫球蛋白对重症支原体肺炎患儿预后及影像学表现的影响分析

Effect of Bronchoalveolar Lavage Combined with Immunoglobulin on the Prognosis and Imaging Performance of Children with Severe Mycoplasma Pneumonia

目的:探讨支气管肺泡灌洗术联合免疫球蛋白对重症支原体肺炎患儿预后及影像学表现的影响。方法:选取2018年1月至2019年12月收治的SMPP患儿150例为研究对象,依照随机数字表法将患儿分为激素组、丙球组及联合治疗组,每组各50例。激素组,男28例、女22例,年龄5~12岁,平均年龄(8.62±1.03)岁,病程7~14d,平均(10.17±1.33)d;丙球组,男30例、女20例,年龄6~12岁,平均年龄(9.14±1.04)岁,病程7~14d,平均(10.22±1.28)d;联合治疗组,男26例、女24例,年龄5~12岁,平均年龄(9.17±1.17)岁,病程7~14d,平均(9.44±1.19)d。激素组采用甲强龙1~2mg·kg^(-1)·d^(-1)静脉滴注5d,并同时予以抗感染、适当补液等基础治疗。丙球组采用免疫球蛋白400mg·kg^(-1)·d^(-1)静脉滴注5d。联合治疗组在丙球组治疗基础上增加支气管肺泡灌洗术。观察三组患儿疗效及治疗前后影像学改变。结果:激素组临床治疗总有效率为86.00%,丙球组总有效率为84.00%,联合治疗组总有效率为96.00%,联合治疗组与激素组、丙球组两两比较差异具有统计学意义(χ^(2)=5.137、4.726,P=0.032、0.011)。三组患儿治疗一周后复查影像学比较病灶吸收情况结果显示,激素组明显吸收16例(占32.00%)、丙球组明显吸收18例(占36.00%)均显著低于联合治疗组22例(占44.00%),差异具有统计学意义(P<0.05);激素组支气管闭塞6例(占12.00%)、丙球组支气管闭塞8例(占16.00%)与联合治疗组4例(占8.00%)比较差异具有统计学意义(P<0.05)。结论:支气管肺泡灌洗术联合免疫球蛋白能有效提高重症支原体肺炎患儿治疗有效率,并促进患儿肺部影像学病灶吸收,值得临床推广。

Objective:To investigate the effect of bronchoalveolar lavage combined with immunoglobulin on the prognosis and imaging performance of children with severe mycoplasma pneumonia.Methods:One hundred and fifty children with SMPP admitted from January 2018 to December 2019 were selected as study subjects,and the children were divided into hormone group,propecia group,and combined treatment group according to the random number table method,with 50 cases in each group.In the hormone group,there were 28 males and 22 females,aged 5-12 years,mean age(8.62±1.03)years,duration of illness 7-14 days,mean(10.17±1.33)days;in the propecia group,there were 30 males and 20 females,aged 6-12 years,mean age(9.14±1.04)years,duration of illness 7-14 days,mean(10.22±1.28)days;in the combination therapy group,there were 26 males and 24 females,mean age(9.14±1.04)years,duration of illness 7-14 days,mean(10.22±1.28)days.group,26 males and 24 females,age 5-12 years,mean age(9.17±1.17)years,duration of disease 7-14 days,mean(9.44±1.19)days.In the hormone group,methylprednisolone 1~2mg/kg-d was administered intravenously for 5 days,and basic treatment such as anti-infection and appropriate rehydration was also given.The C-ball group was treated with immunoglobulin 400mg/kg-d intravenously for 5 days.In the combined treatment group,bronchoalveolar lavage was added on top of the treatment in the propofol group.The efficacy of the three groups and the imaging changes before and after treatment were observed.Results:The total effective rate of clinical treatment was 86.00%in the hormone group,84.00%in the propofol group,and 96.00%in the combined treatment group.The difference between the combined treatment group and the hormone and propofol groups was statistically significant(χ^(2)=5.137,4.726,P=0.032,0.011).The results of the review of imaging after one week of treatment in the three groups showed that 16 cases(32.00%)of significant absorption in the hormone group and 18 cases(36.00%)of significant absorption in the propofol group were significantly lower than 22 cases(44.00%)in the combined treatment group,and the difference was statistically significant(P<0.05);6 cases(12.00%)of bronchial occlusion in the hormone group and 8 cases(12.00%)of bronchial occlusion in the propofol group were statistically significant.The differences were statistically significant(P<0.05)when comparing 8 cases(16.00%)of bronchial occlusion in the hormone group(12.00%)and 8 cases(8.00%)in the propofol group with 4 cases(8.00%)in the combined treatment group.Conclusion:Bronchoalveolar lavage combined with immunoglobulin can effectively improve the treatment efficiency of children with severe mycoplasma pneumonia and promote the absorption of lung imaging lesions in children,which is worthy of clinical promotion.