纤维支气管镜下肺泡灌洗治疗小儿肺炎支原体大叶性肺炎的临床疗效分析

卢保霞; 陈荣寿; 汪珊; 彭万胜; 周瑞

doi:10.16766/j.cnki.issn.1674-4152.002005

纤维支气管镜下肺泡灌洗治疗小儿肺炎支原体大叶性肺炎的临床疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.002005

1.
安徽省医科大学附属六安医院(六安市人民医院)儿科, 安徽六安 237005
2.
蚌埠医学院附属第一医院儿科, 安徽蚌埠 233004

基金项目:

安徽高校自然科学研究项目 KJ2019A0365

详细信息

通讯作者:
周瑞，E-mail: 1176034941@qq.com

中图分类号: R725.6 R563.15
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- 文章访问数: 212
- HTML全文浏览量: 100
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-21
- 网络出版日期: 2022-02-16

Clinical efficacy of fiberoptic bronchoscopy alveolar lavage in the treatment of Mycoplasma pneumoniae lobar pneumonia in children

1.
Department of Pediatrics, Lu'an Hospital Affiliated to Anhui Medical University (Lu'an People's Hospital), Lu'an, Anhui 237005, China

摘要

摘要: 目的观察小儿肺炎支原体(MP)大叶性肺炎在运用纤维支气管镜下肺泡灌洗治疗后的临床疗效及炎性指标、免疫力变化。方法选取2019年4月—2020年9月在六安市人民医院儿科住院的60例MP感染引起大叶性肺炎改变患儿作为观察对象，按随机数字表法分为观察组和对照组各30例。对照组给予常规肺炎支原体治疗，观察组在常规治疗基础上给予纤维支气管镜下肺泡灌洗治疗。比较2组临床疗效(主要包括住院时间，咳嗽消失时间，体温恢复时间)、炎性因子水平、细胞免疫力、体液免疫力指标变化情况。结果 (1) 治疗后肺部CT复查肺部恢复情况，观察组肺部阴影完全消失18例、部分消失10例、未有变化2例，观察组明显优于对照组，差异有统计学意义(P < 0.05)。(2)观察组咳嗽消失时间[(4.89±1.74)d]、发热时间[(2.63±0.56)d]、住院天数[(7.45±1.68)d]均少于对照组[(6.43±1.33)d、(3.85±1.29)d、(9.90±1.32)d], 差异有统计学意义(均P < 0.05)。(3)2组经过治疗后实验室指标比较，WBC、血清降钙素原(PCT)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α), CD3⁺、CD4⁺、CD4⁺/CD8⁺, IgA、IgM、IgG水平观察组均明显优于对照组，差异均有统计学意义(均P < 0.05)。结论纤维支气管镜下肺泡灌洗治疗肺炎支原体大叶性肺炎可明显提高临床疗效，减轻炎症反应，加快患儿免疫力恢复。
- 小儿肺炎支原体肺炎 /
- 大叶性肺炎 /
- 纤维支气管镜下肺泡灌洗 /
- 炎性指标 /
- 免疫力指标
Abstract: Objective To observe the clinical curative effect, inflammatory index and immunity changes of Mycoplasma pneumoniae (MP) lobar pneumonia in children after treatment with fiberoptic bronchoscope alveolar lavage. Methods Total 60 children with lobar pneumonia caused by MP infection in the Department of Pediatrics of Lu'an people's Hospital from April 2019 to September 2020 were selected and randomly divided into observation group and control group with 30 cases in each group. The control group was given conventional treatment of Mycoplasma pneumoniae, and the observation group was given bronchoalveolar lavage under fiberoptic bronchoscope on the basis of conventional treatment. The clinical efficacy (including hospitalization time, cough disappearance time, body temperature recovery time), inflammatory factor levels, cellular immunity and humoral immunity indexes were compared between the two groups. Results (1) After treatment, the results of chest CT reexamination in the observation group showed that the lung shadow completely disappeared in 18 cases, partially disappeared in 10 cases, no change in 2 cases, the observation group was significantly better than the control group, the difference was statistically significant (P < 0.05). (2) In the observation group, cough disappearance time[(4.89±1.74) d], fever time[(2.63±0.56) d] and hospitalization days[(7.45±1.68) d] were less than those in the control group[(6.33±1.33) d, (3.85±1.29) d, (9.90±1.32) d, P < 0.05]. (3) Two sets of laboratory indexes after treatment, the levels of WBC, PCT, IL-6, TNF -α, CD3⁺, CD4⁺, CD4⁺/CD8⁺, IgA、IgM、IgG in the observation group were significantly better than those in the control group (all P < 0.05). Conclusion Bronchoalveolar lavage under fiberoptic bronchoscopy in the treatment of Mycoplasma pneumoniae lobar pneumonia can significantly improve the clinical efficacy, reduce inflammatory reaction, and accelerate the recovery of children's immunity.
- Mycoplasma pneumoniae pneumonia in children /
- Lobar pneumonia /
- Bronchoalveolar lavage under fiberoptic bronchoscope /
- Inflammatory index /
- Immunity index

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表 1 2组大叶性肺炎患儿治疗后疗效及临床指标对比

组别	例数	完全消失(例)	部分消失(例)	未消失(例)	咳嗽消失时间(x±s，d)	体温恢复正常时间(x±s，d)	住院时间(x±s，d)
观察组	30	18	10	2	4.89±1.74	2.63±0.56	7.45±1.68
对照组	30	9	14	7	6.43±1.33	3.85±1.29	9.90±1.32
统计量			-3.790^a		-3.862^b	-4.731^b	-6.268^b
P值			< 0.001		< 0.001	< 0.001	< 0.001
注：^a为Z值，^b为t值。

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表 2 2组大叶性肺炎患儿炎性指标及免疫学指标比较(x ±s)

组别	例数	WBC(×10⁹/L)		PCT(pg/mL)			IL-6(pg/mL)			TNF-α(pg/mL)
组别	例数	治疗前1 d	治疗后第7天	治疗前1 d	治疗后第7天		治疗前1 d	治疗后第7天		治疗前1 d	治疗后第7天
观察组	30	10.88±1.89	7.72±1.59^a	224.42±49.75	87.25±27.23^a		64.12±17.46	30.91±18.10^a		121.4±22.32	45.27±10.47^a
对照组	30	10.56±2.15	9.30±1.93^a	217.50±68.32	113.0±26.20^a		62.68±18.50	45.20±21.24^a		129.6±23.11	57.70±20.62^a
t值		0.612	-3.461	0.449	-4.189		0.310	-2.728		-1.388	-2.9474
P值		0.543	0.001	0.656	< 0.001		0.758	0.008		0.170	0.001

组别	例数	CD3⁺(%)		CD4⁺(%)			CD8⁺(%)			CD4⁺/CD8⁺
组别	例数	治疗前1 d	治疗后第7天	治疗前1 d	治疗后第7天		治疗前1 d	治疗后第7天		治疗前1 d	治疗后第7天
观察组	30	54.86±3.63	60.74±3.18^a	26.24±2.90	35.40±2.50^a		28.85±2.72	25.37±2.44^a		0.91±0.08	1.41±0.18^a
对照组	30	54.54±3.13	57.61±3.21^a	26.47±2.11	30.64±1.97^a		29.53±2.78	27.61±2.70^a		0.90±0.05	1.12±0.11^a
t值		0.373	3.801	-0.344	8.205		-0.959	-3.354		0.725	7.469
P值		0.711	< 0.001	0.732	< 0.001		0.341	0.001		0.471	< 0.001

组别	例数	IgA(g/L)			IgM(g/L)				IgG(g/L)
组别	例数	治疗前1 d	治疗后第7天		治疗前1 d	治疗后第7天			治疗前1 d	治疗后第7天
观察组	30	1.96±0.52	1.23±0.44^a		2.05±0.61	1.51±0.43^a			10.49±2.38	4.87±1.00^a
对照组	30	1.98±0.42	1.51±0.38^a		2.04±0.45	1.79±0.48^a			10.32±2.20	5.96±1.45^a
t值		-0.213	-2.636		0.089	-2.357			0.285	-3.361
P值		0.832	0.011		0.929	0.022			0.776	0.001
注：与治疗前1 d比较，^aP＜0.05。

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