纤维支气管镜肺泡灌洗治疗儿童难治性肺炎支原体肺炎的临床观察

蒋美红; 袁琛

doi:10.16766/j.cnki.issn.1674-4152.003883

纤维支气管镜肺泡灌洗治疗儿童难治性肺炎支原体肺炎的临床观察

doi: 10.16766/j.cnki.issn.1674-4152.003883

蒋美红^1, ,,
袁琛²

1.
长兴县人民医院儿科，浙江湖州 313100
2.
湖州市第一人民医院儿科，浙江湖州 313000

基金项目:

浙江省卫生健康科技计划项目 2021KY348

详细信息

通讯作者:
蒋美红，E-mail：jiangmeihong123@163.com

中图分类号: R725.6 R563.15
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- 文章访问数: 9
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- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-10
- 网络出版日期: 2025-03-27

Clinical observation of fiberoptic bronchoscopy bronchoalveolar lavage in the treatment of refractory Mycoplasma pneumonia pneumonia in children

JIANG Meihong^{1
, ,},
YUAN Chen²

1.
Department of Pediatrics, Changxing County People ' s Hospital, Huzhou, Zhejiang 313100, China

摘要

摘要: 目的儿童难治性肺炎支原体肺炎(RMPP)治疗难度较大，为提高患儿预后水平，探讨纤维支气管镜肺泡灌洗治疗儿童RMPP的临床效果。方法选取2020年6月—2024年6月长兴县人民医院收治的90例RMPP患儿为研究对象，采用随机数表法将患儿分为对照组(45例)和观察组(45例)。2组基本治疗方法相同，观察组增加纤维支气管镜肺泡灌洗治疗。评价2组RMPP临床疗效、临床症状改善情况、血清炎症标志物和肺损伤标志物水平，随访治疗结束后1个月内RMPP相关并发症情况。结果观察组RMPP总体治疗有效率[97.78%(44/45)]高于对照组[82.22%(37/45), χ²=4.444，P=0.035]；观察组发热、咳嗽、肺部湿啰音等肺炎临床症状持续时间均短于对照组(P < 0.001)；观察组治疗后血清铁蛋白和乳酸脱氢酶水平均低于对照组；观察组治疗后血清TNF-α、hs-CRP、降钙素原、IL-6水平均低于对照组(P < 0.001)；观察组治疗结束后1个月内RMPP相关并发症总发生率[4.44%(2/45)]显著低于对照组[20.00%(9/45), P < 0.05]。结论纤维支气管镜肺泡灌洗可用于治疗儿童RMPP，通过清除气道炎症分泌物，减轻炎症反应和肺损伤，促进临床症状迅速改善，提高疗效。
- 难治性肺炎支原体肺炎 /
- 纤维支气管镜肺泡灌洗 /
- 临床疗效 /
- 儿童
Abstract: Objective The treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children is difficult. In order to improve the prognosis of children, this study explores the clinical effect of fiberoptic bronchoscopy bronchoalveolar lavage in the treatment of RMPP in children. Methods A total of 90 children with RMPP admitted to Changxing County People ' s Hospital from June 2020 to June 2024 were selected as the research objects. The children were divided into the control group (45 cases) and the observation group (45 cases) by the random number table method. The two groups received the same basic treatment, with the observation group receiving treatment with fiberoptic bronchoscopy and bronchoalveolar lavage. The clinical efficacy, improvement of clinical symptoms, levels of serum inflammatory markers and lung injury markers of RMPP were evaluated, and RMPP related complications within one month after the end of treatment was followed up. Results The overall treatment efficacy rate of RMPP in the observation group [97.78% (44/45)] was significantly higher than that in the control group [82.22% (37/45), χ²=4.444, P=0.035]. The duration of clinical symptoms such as fever, cough, and wet rales in the observation group were significantly shorter than those in the control group (P < 0.001). The serum SF and LDH levels in the observation group after treatment were significantly lower than those in the control group. The serum levels of TNF-α, hs-CRP, PCT, and IL-6 in the observation group after treatment were significantly lower than those in the control group (P < 0.001). The overall incidence of RMPP related complications within one month after treatment in the observation group [4.44% (2/45)] was significantly lower than that in the control group [20.00% (9/45), P < 0.05]. Conclusion Fiberoptic bronchoscopy bronchoalveolar lavage is used to treat RMPP in children, by clearing airway inflammatory secretions, reducing inflammatory reactions and lung damage, promoting rapid improvement of clinical symptoms, and enhancing efficacy.
- Difficult to treat Mycoplasma pneumoniae pneumonia /
- Fiberoptic bronchoscopy bronchoalveolar lavage /
- Clinical efficacy /
- Children

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表 1 2组RMPP患儿临床总有效率比较[例(%)]

Table 1. Comparison of overall clinical efficacy between the two groups of children with RMPP[cases (%)]

组别	例数	显效	有效	无效	总有效
对照组	45	23(51.11)	14(31.11)	8(17.78)	37(82.22)
观察组	45	34(75.56)	10(22.22)	1(2.22)	44(97.78)
注：2组总有效率比较，χ²=4.444，P=0.035。

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表 2 2组RMPP患儿临床症状改善情况比较(x±s，d)

Table 2. Comparison of improvement in clinical symptoms between the two groups of children with RMPP(x±s, d)

组别	例数	发热持续时间	咳嗽持续时间	肺部湿啰音持续时间
对照组	45	12.41±1.49	13.75±1.63	14.23±1.57
观察组	45	9.86±1.02	11.06±1.28	11.65±1.31
t值		9.473	8.493	8.672
P值		< 0.001	< 0.001	< 0.001

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表 3 2组RMPP患儿治疗前后血清肺损伤标志物比较(x±s)

Table 3. Comparison of serum markers of lung injury in 2 groups of RMPP children before and after treatment(x±s)

组别	例数	SF(μg/L)		LDH(U/L)
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	45	462.51±54.32	274.35±39.06^b	443.27±52.63	194.62±22.37^b
观察组	45	465.79±56.48	159.47±20.53^b	429.59±53.74	137.74±18.63^b
统计量		0.281^a	31.527^c	1.220^a	26.934^c
P值		0.779	< 0.001	0.226	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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表 4 2组RMPP患儿治疗前后血清炎症标志物水平比较(x±s)

Table 4. Comparison of serum inflammatory markers before and after treatment in 2 groups of children with RMPP(x±s)

组别	例数	TNF-α(μg/L)		hs-CRP(U/L)		PCT(μg/L)		IL-6(ng/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	45	74.93±8.53	46.29±5.16^b	48.61±5.17	19.34±2.11^b	1.19±0.24	0.47±0.11^b	52.28±6.24	17.62±2.39^b
观察组	45	73.81±8.47	37.52±4.31^b	49.03±5.24	13.69±1.57^b	1.16±0.26	0.32±0.09^b	51.61±6.39	10.23±1.25^b
统计量		0.625^a	16.253^c	0.383^a	25.476^c	0.569^a	21.028^c	0.503^a	19.847^c
P值		0.534	< 0.001	0.703	< 0.001	0.571	< 0.001	0.616	< 0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP < 0.05。

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表 5 2组RMPP患儿相关并发症发生情况比较[例(%)]

Table 5. Comparison of related complications in 2 groups of children with RMPP[cases (%)]

组别	例数	胸腔积液	肺不张	坏死性肺炎	闭塞性支气管炎	总发生
对照组	45	3(6.67)	1(2.22)	1(2.22)	4(8.89)	9(20.00)
观察组	45	1(2.22)	0	0	1(2.22)	2(4.44)
注：2组并发症总发生率比较，χ²=5.075，P=0.024。

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