乙酰半胱氨酸溶液联合电子支气管镜肺泡灌洗术对小儿重症肺炎呼吸力学和炎症反应的影响

Effects of acetylcysteine solution combined with broncho-alveolar lavage on respiratory mechanics and inflammation in children with severe pneumonia

目的乙酰半胱氨酸溶液联合电子支气管镜肺泡灌洗术(BAL)对小儿重症肺炎(SP)呼吸力学和炎症反应的影响。方法选取2020年1月至2021年10月聊城市东昌府人民医院收治的92例SP患儿作为研究对象,按照随机数字表法分为观察组与对照组,每组46例。对照组开展BAL治疗,观察组在对照组治疗基础上联合乙酰半胱氨酸溶液雾化吸入治疗,比较两组临床疗效、呼吸力学指标[动态顺应性(Cdyn)、呼吸做功(WOB)、气道阻力(Raw)]、炎症因子[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、高迁率族蛋白B1(HMGB-1)]、症状消失时间及不良反应发生情况。结果观察组治疗总有效率为95.65%,高于对照组的82.61%,差异有统计学意义(P<0.05)。治疗后,观察组WOB、Raw均明显低于对照组,Cdyn明显高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组CRP、IL-6、HMGB-1水平均低于对照组,差异有统计学意义(P<0.05)。观察组肺部X线阴影消失时间、气喘消失时间、湿啰音消失时间、发热消失时间均明显短于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论与BAL单纯治疗小儿SP相比,BAL联合乙酰半胱氨酸溶液治疗的疗效更显著,可有效改善患儿呼吸力学,减轻机体炎症反应,快速缓解多种临床症状,加速患儿恢复,且安全可靠。

Objective To investigate the effects of acetylcysteine solution combined with broncho-alveolar lavage(BAL)on respiratory mechanics and inflammation in children with severe pneumonia(SP).Methods 92 children with SP treated in Dongchangfu People's Hospital of Liaocheng City from January 2020 to October 2021 were selected as the study subjects,and they were divided into the observation group and the control group according to random number table method,with 46 cases in each group.The control group received BAL treatment,and the observation group was combined with atomization inhalation of acetylcysteine solution on the basis of the control group.The clinical efficacy,respiratory mechanical indicators(dynamic compliance[Cdyn],work of breathing[WOB],airway resistance[Raw]),inflammatory factors(C-reactive protein[CRP],interleukin-6[IL-6],high mobility group box-1 protein[HMGB-1]),time of symptom disappearance and occurrence of adverse reactions were compared between the two groups.Results The total effective rate in the observation group was 95.65%,which was higher than 82.61%in the control group,the difference was statistically significant(P<0.05).After treatment,the WOB and Raw in the observation group were significantly lower than those in the control group,and the Cdyn were significantly higher than those in the control group,the differences were statistically significant(P<0.05);the levels of CRP,IL-6 and HMGB-1 in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The disappearance time of lung X-ray shadow,asthma,moist rales and fever in the observation group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Compared with BAL alone in the treatment of SP in children,BAL combined with acetylcysteine solution is more effective,can effectively improve the respiratory mechanics of children,reduce the body inflammatory response,quickly relieve various clinical symptoms,accelerate the recovery of children,and is safe and reliable.