电子支气管镜支气管肺泡灌洗术辅助治疗儿童重症肺炎并发肺不张的效果

Effectiveness of electronic bronchoscopic bronchoalveolar lavage as an adjunct in the treatment of severe pneumonia complicated by pulmonary atelectasis in children

目的探究电子支气管镜支气管肺泡灌洗术辅助治疗儿童重症肺炎并发肺不张的效果。方法选取2019年9月—2022年9月本院收治的重症肺炎并发肺不张患儿92例,随机分为2组,各46例。对照组43例(3例未签字同意)患儿接受常规方案的治疗,观察组44例(2例未签字同意)患儿在对照组基础之上接受电子支气管镜支气管肺泡灌洗术治疗。治疗后,记录2组咳嗽咳痰与气促气短恢复时间、住院时间以及治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、动态顺应性(Cdyn)、气道阻力(Raw)等指标,并进行比较。结果观察组治疗有效率为95.45%,对照组为79.07%,差异有统计学意义(χ^(2)=5.286,P=0.021);观察组咳嗽咳痰与气促气短恢复时间、住院时间分别为(8.56±1.33)d、(6.25±0.75)d、(18.16±3.15)d,对照组分别为(12.34±1.89)d、(9.04±1.45)d、(24.15±3.46)d,差异均有统计学意义(t=10.808、11.310、8.447,P均<0.001)。治疗后,观察组TNF-α、IL-6、IL-8水平分别为(17.26±3.47)ng/L、(3.46±0.87)ng/L、(5.98±0.85)ng/L,对照组分别为(23.55±3.91)ng/L、(5.78±1.21)ng/L、(9.12±1.13)ng/L,差异均有统计学意义(t=7.941、10.286、14.669,P均<0.001)。治疗后,观察组Cdyn为(35.74±6.14)mL/cmH2O,对照组为(29.66±5.32)mL/cmH2O,差异有统计学意义(t=4.931,P<0.001),观察组Raw为(9.64±1.91)cmH2O/(L·s),对照组为(12.45±2.47)cmH2O/(L·s),差异有统计学意义(t=5.944,P<0.001)。结论电子支气管镜支气管肺泡灌洗术辅助治疗重症肺炎并发肺不张患儿能够有效提升治疗有效率、缓解炎症反应并改善肺功能,具有较高的应用价值。

Objective This study was aimed at exploring the effects of bronchoalveolar lavage with electronic bronchoscope assistance in the treatment of severe pneumonia complicated with atelectasis among children.Methods A total of 92 children with severe pneumonia complicated with atelectasis admitted to our hospital between September 2019 and September 2022 were selected and randomly divided into a control group and observation group.The control group comprised 46 children;three children lacked signed consent for study participation,and 43 children actually participated in the study.The children received conventional treatment.The observation group comprised 46 children;two children lacked signed consent for study participation,and 44 children actually participated in the study.The children received electronic bronchoscope bronchoalveolar lavage.After treatment,the disappearance time of cough,expectoration,and shortness of breath;total hospital stay;and tumor necrosis factor(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),dynamic compliance(Cdyn),airway resistance(Raw),and other indicators were compared.Results The rate of treatment effectiveness in the observation group was 95.45%,and that in the control group was 79.07%;the difference was statistically significant(χ^(2)=5.286,P=0.021).After treatment,the disappearance time of cough,expectoration,and shortness of breath,and the total hospital stay were 8.56±1.33 days,6.25±0.75 days,and 18.16±3.15 days,respectively,in the observation group,and 12.34±1.89 days,9.04±1.45 days,and 24.15±3.46 days,respectively,in the control group.The difference was statistically significant.(t=10.808,11.310,8.447,all P<0.001).After treatment,in the observation group,the TNF-α,IL-6,and IL-8 levels were 17.26±3.47 ng/L,3.46±0.87 ng/L,and 5.98±0.85 ng/L,respectively,whereas those in the control group were 23.55±3.91 ng/L,5.78±1.21 ng/L,and 9.12±1.13 ng/L,respectively;the difference was statistically significant.(t=7.941,10.286,14.669,all P<0.001).After treatment,Cdyn was 35.74±6.14 mL/cmH2O in the observation group and 29.66±5.32 mL/cmH2O in the control group,with a statistically significant difference(t=4.931,P<0.001).Raw was 9.64±1.91 cmH2O/(L·s)in the observation group and 12.45±2.47 cmH2O/(L·s)in the control group,with a statistically significant difference(t=5.944,P<0.001).Conclusion Bronchoalveolar lavage with an electronic bronchoscope effectively improved the treatment efficiency,alleviated inflammatory reactions,and improved lung function in children with severe pneumonia complicated with atelectasis,and therefore has high application value.