支气管肺泡灌洗治疗儿童支原体肺炎并肺不张的疗效观察

Observation of bronchoalveolar lavage in the treatment of children with Mycoplasma pneumoniae pneumonia and atelectasis

目的:探讨儿童支原体肺炎并肺不张的临床特点及纤维支气管镜下支气管肺泡灌洗的治疗效果。方法:收治儿童支原体肺炎并肺不张患儿165例,对临床资料进行回顾性分析。结果:165例儿童支原体肺炎并肺不张年龄3～15岁,临床均表现有发热(100%),咳嗽(100%);所有患儿胸部CT提示双侧或单侧肺实变,合并不同部位的肺不张(100%),有胸腔积液5例;165例患儿胸部X线均提示肺炎,合并肺不张147例(89.1%);53例患儿进行纤支镜检查及进行支气管肺泡灌洗治疗,纤支镜下均见病变部位不同程度的黏膜水肿,支气管口痰栓,炎性狭窄。纤支镜灌洗组体温下降正常时间平均3.2±2.6天;明显低于对照组6.8±4.2天(t=11.34,P<0.01)。灌洗组治疗有效率96%,明显高于对照组的77%(χ2=8.23,P<0.05)。结论:发热及咳嗽是儿童支原体肺炎并肺不张的主要症状,胸部CT检查有助于明确病灶范围,治疗儿童支原体肺炎除了应用大环内酯类抗生素外,早期应用纤支镜进行支气管肺泡灌洗治疗能够促进肺复张,提高疗效,缩短病程。

Objective:To explore the clinical characteristics and the treatment effects of bronchoalveolar lavage under fiberoptic bronchoscopy in children with mycoplasma pneumoniae pneumonia and atelectasis.Method:The clinical data of 165 cases of children with mycoplasma pneumoniae pneumonia and atelectasis diagnosed in hospital was analyzed retrospectively,from January 2009 to June 2013.Result:165 cases of children with MP peumonia and atelectasis,aged 3 to 15 years,presented with fever(100%) and cough(100%).All the children have bilateral or unilateral lung consolidation in chest CT,with atelectasis in different parts(100%) and 5 cases with pleural effusion.165 cases were all performed pneumonia in X-ray and 147 cases showed atelectasis(89.1%).Fiberoptic bronchoscopy and bronchoalveolar lavage were operated on 53 cases.The fiberoptic bronchoscopy detection results included different degrees of mucosal edema in diseased region,phlegm and embolism in the bronchus and inflammatory stricture.The febrile time of the bronchoscopy treatment group was 3.2±2.6 days on average and it is significantly shorter than the control group(6.8±4.2days)(t=11.34,P<0.01).The efficient of the bronchoscopy treatment group was 99% and it is significantly higher than the control group,which was 77%(X2=8.23,P<0.05).Conclusion:Fever and cough are the main symptoms in children with MP pneumonia and atelectasis.Chest CT examination is helpful to confirm lesions.Besides macrolide antibiotics,early application of bronchoalveolar lavage under fiberoptic bronchoscopy can promote pulmonary reexpansion and improve efficacy and shorten course in the treatment of children with MP pneumonia.