早期FOB介入联合药物雾化与阿奇霉素治疗小儿肺炎支原体肺炎伴发气道黏液栓塞的效果观察

Observation of the effect of early FOB intervention combined with drug atomization and azithromycin in the treatment of children with mycoplasmal pneumoniae pneumonia complicated with airway mucus embolism

目的 观察早期光导纤维支气管镜(FOB)介入联合药物雾化与阿奇霉素治疗小儿肺炎支原体肺炎伴发气道黏液栓塞的效果。方法 前瞻性选取2020年1月至2022年6月菏泽市立医院收治的120例小儿肺炎支原体肺炎伴发气道黏液栓塞为患儿研究对象,按照简单随机法将其分为观察组和对照组,每组各60例。对照组给予阿奇霉素静脉滴注,布地奈德联合特布他林雾化吸入治疗,观察组在对照组基础上给予早期FOB介入治疗。观察两组临床一般情况(实验室指标恢复时间、胸片恢复时间、退热时间、住院时间)。比较两组治疗前、治疗1周后呼吸力指标(肺容积和肺静态顺应性、气道平台压)、血清因子[白细胞计数(WBC)、淋巴细胞计数(LYM)、C-反应蛋白(CRP)、红细胞沉降率(ESR)、D-二聚体、乳酸脱氢酶(LDH)]水平,并记录两组影像学下坏死性肺炎、肺不张、肺部实变吸收面积≥90%发生情况。结果 观察组的WBC、CRP恢复正常时间、胸部CT恢复正常时间、退热时间、住院时间均明显短于对照组,差异均有统计学意义(P<0.05)。治疗1周后,两组肺容积和肺静态顺应性均较治疗前升高,而气道平台压均较治疗前降低,且观察组的肺容积和肺静态顺应性均高于对照组,气道平台压低于对照组,差异均有统计学意义(P<0.05)。治疗1周后,两组WBC、LYM、CRP、ESR、D-二聚体、LDH水平均较治疗前降低,且观察组的WBC、LYM、CRP、ESR、D-二聚体、LDH水平均低于对照组,差异均有统计学意义(P<0.05)。观察组肺部实变吸收面积≥90%占比为83.33%,高于对照组(56.67%),而坏死性肺炎和肺不张发生率分别为8.33%、3.33%,均低于对照组(21.67%、15.00%),差异均有统计学意义(P<0.05)。结论 早期FOB介入联合药物雾化与阿奇霉素治疗小儿肺炎支原体肺炎伴发气道黏液栓塞可缩短病程,改善呼吸力指标,促进肺部实变吸收,减少坏死性肺炎和肺不张的发生,可能与降低相关血清因子有关。

Objective To observe the effect of early fiberoptic bronchoscopy(FOB)intervention combined with drug atomization and azithromycin in the treatment of children with mycoplasmal pneumoniae pneumonia complicated by airway mucus embolism.Methods One hundred and twenty cases of children with pediatric mycoplasma pneumoniae pneumonia with developmental airway mucus embolism admitted to Heze Municipal Hospital from January 2020 to June 2022 were prospectively selected for the study,and they were divided into the observation group and the control group by simple randomization method,with 60 cases in each group.The control group was given azithromycin intravenous drip,budesonide combined with terbutaline nebulized inhalation treatment,and the observation group was given early FOB intervention on the basis of the control group.The general clinical conditions(laboratory indicators recovery time,chest X-ray recovery time,fever reduction time,hospital stay)of the two groups were observed.The respiratory indicators(lung volume and static compliance,airway plateau pressure),serum factors[white blood cell count(WBC),lymphocyte count(LYM),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),D-dimer,lactate dehydrogenase(LDH)]levels were compared between the two groups before and after 1 week of treatment,and the occurrence of necrotizing pneumonia,atelectasis,and consolidation of the lungs with absorption area≥90%were recorded.Results The recovery time of WBC,CRP,chest X-ray,fever reduction time,hospital stay in the observation group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).After 1 week of treatment,the lung volume and static compliance of two groups were higher than those before treatment,while the airway plateau pressure of two groups were lower than those before treatment,the lung volume and static compliance of the observation group were higher than those of the control group,and the airway plateau pressure was lower than that of the control group,and the differences were statistically significant(P<0.05).After 1 week of treatment,the levels of WBC,LYM,CRP,ESR,D-dimer,and LDH in two groups were lower than those before treatment,and the levels of WBC,LYM,CRP,ESR,D-dimer,and LDH in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The percentage of absorbed area of solid lung lesions≥90%in the observation group was 83.33%,which was higher than that in the control group(56.67%),while necrotizing pneumonia and pulmonary atelectasis were 8.33%,3.33%,which were lower than those in the control group(21.67%,15.00%),and the differences were statistically significant(P<0.05).Conclusion Early FOB intervention combined with pharmacological nebulization and azithromycin for pediatric mycoplasma pneumoniae pneumonia with airway mucus embolism shortens the course of the disease,improves respiratory force indexes,promotes absorption of lung solids,and reduces the incidence of necrotizing pneumonia and pulmonary atelectasis,possibly related to the reduction of associated serum factors.