乙酰半胱氨酸肺泡灌洗联合支气管镜肺泡灌洗术对儿童肺实变及肺不张的治疗效果和安全性评价

Evaluation of therapeutic effect and safety of bronchoscopic alveolar lavage combined with acetylcysteine alveolar lavage on pulmonary consolidation and atelectasis in children

目的分析和评价乙酰半胱氨酸(NAC)肺泡灌洗联合支气管镜肺泡灌洗术对儿童肺实变及肺不张的治疗效果和安全性。方法选取146例肺实变及肺不张患儿作为研究对象,分为研究组(48例,采用NAC肺泡灌洗联合支气管镜肺泡灌洗术治疗)和对照组(98例,采用支气管镜肺泡灌洗术治疗)。对两组患儿的临床疗效、治疗指标、实验室指标、动脉血气指标、肺功能指标和氧合指数(OI)、血清表面活性物质相关蛋白-A(SP-A)、氧化应激指标及安全性进行对比分析。结果研究组患儿的疗效优于对照组(P<0.05)。研究组患儿的肺部啰音消失时间、体温恢复时间、住院时间均短于对照组,差异均有统计学意义(P<0.001)。两组患儿治疗前实验室指标、动脉血气指标、肺功能指标、OI的差异均无统计学意义;在灌洗治疗后,两组患儿的外周血白细胞计数(WBC)、血清C反应蛋白(CRP)、降钙素原(PCT)水平、动脉二氧化碳分压(PaCO_(2))水平均较治疗前降低,动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)占FVC的百分比(FEV_(1)/FVC)、OI水平均较治疗前升高,同组治疗前后的差异均有统计学意义(P<0.001);研究组患儿治疗后的WBC、CRP、PCT、PaCO_(2)水平均低于对照组,PaO_(2)、SaO_(2)、FEV_(1)、FCV、FEV_(1)/PVC、OI水平均高于对照组,两组间的差异均有统计学意义(P<0.001)。两组患儿治疗前血清SP-A水平和氧化应激指标的差异均无统计学意义;在灌洗治疗后,两组患儿血清SP-A、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平均较治疗前升高,血清丙二醛(MDA)水平均较治疗前下降,同组治疗前、后的差异均有统计学意义(P<0.001);研究组患儿治疗后的血清SP-A、SOD、GSH-Px水平均高于对照组,血清MDA水平低于对照组,两组之间的差异均有统计学意义(P<0.001)。两组不良反应的发生率无统计意义。结论针对儿童肺实变和肺不张,在支气管镜肺泡灌洗术治疗中联合采用NAC肺泡灌洗治疗,可提升临床疗效,显著缓解患儿炎症反应和氧化应激水平,改善肺功能和动脉血气指标,提升组织氧合水平,促进肺组织顺应性恢复,不会增加治疗不良反应。

Objective To analyze and evaluate the therapeutic efficacy and safety of alveolar lavage with acetylcysteine(NAC)combined with bronchoscopic alveolar lavage in children with pulmonary solid changes and pulmonary atelectasis.Methods A total of 146 children with pulmonary solid changes and pulmonary atelectasis were selected as study subjects and divided into study group(48 cases,treated with NAC alveolar lavage combined with bronchoscopic alveolar lavage)and control group(98 cases,treated with bronchoscopic alveolar lavage).The therapeutic efficacy and safety of the children in two groups were compared and analyzed.Results The efficacy of the children in study group was better than that of control group(P<0.05).The disappearance time of lung rales,temperature recovery time and hospitalization time of the children in the study group were shorter than those in control group,and the differences were statistically significant(P<0.001).The differences in laboratory indexes,arterial blood gas indexes,pulmonary function indexes,and OI before treatment were not statistically significant between two groups.After lavage treatment,the WBC,CRP,PCT level,and PaCO_(2)level of the children in two groups were lower than those before treatment,and PaO_(2),SaO_(2),FEV_(1),FCV,FEV_(1)/PVC,and OI levels were all higher than before treatment,and the differences between the same groups before and after treatment were statistically significant(P<0.001).The WBC,CRP,PCT,and PaCO_(2)levels of the children in study group were lower than those of control group,and the levels of PaO_(2),SaO_(2)FEV_(1),FCV,FEV_(1)/PVC,and OI were higher than those of control group,with statistically significant differences between both groups(P<0.001).The levels of WBC,CRP,PCT,and PaCO_(2)were lower than those of control group after treatment.The differences were statistically significant(P<0.001).The differences in serum SP-A levels and oxidative stress indicators before treatment were not statistically significant between two groups.After lavage treatment,serum SP-A,SOD,and GSH-PX levels of two groups were higher than before treatment,and serum MDA levels were lower than before treatment,and the differences between the same groups before and after treatment were statistically significant(P<O.001).Serum SP-A,SOD,and GSH-PX levels of the children in study group were higher than before treatment,and serum MDA levels decreased compared to the pre-treatment period,and the differences between the same groups before and after treatment were statistically significant(P<0.001).Serum SP-A,SOD and GSH-PX levels of children in study group were higher than those of control group,and serum MDA levels were lower than those of control group,and the differences between two groups were statistically significant(P<0.001).The incidence of adverse reactions in two groups was not statistically significant.Conclusion For children with pulmonary solid lesions and pulmonary atelectasis,the combined use of NAC alveolar lavage treatment in bronchoscopic alveolar lavage treatment can enhance clinical efficacy,significantly alleviate the level of inflammatory response and oxidative stress in children,improve lung function and arterial blood gas index,enhance the level of tissue oxygenation,and promote the restoration of the compliance of the lung tissues,and will not increase the adverse reactions of the treatment.