支气管镜肺泡灌洗术治疗儿童支原体肺炎并肺实变的疗效观察
|
摘要
目的探讨电子支气管镜肺泡灌洗术治疗儿童支原体肺炎并肺实变的疗效。方法选取2015年3月～2017年10月入住昆明市儿童医院综合内科,确诊为支原体肺炎的患儿135例,经X光胸片或CT证实为肺实变的患儿随机分为灌洗组和对照组,灌洗组68例,对照组67例。对照组给予常规抗支原体等对症治疗,灌洗组在给予常规治疗基础上行电子支气管镜灌洗治疗。比较分析两组患儿术前发热时间、住院时间、平均病程以及肺部影像学恢复情况。结果灌洗组发热时间、住院时间、平均病程以及肺部影像学恢复情况均优于对照组,灌洗组总有效率为100.0%,对照组为83.6%,差异有统计学意义(P<0.05)。结论在儿童支原体肺炎并肺实变治疗中,进行电子支气管镜灌洗治疗能更快改善临床症状,缩短病程,促进肺复张,是一种较有效的方法,值得在临床上推广。
Objective To explore the efficacy of electron bronchoscopy alveolar lavage in children with mycoplasmal pneumonia and pulmonary consolidation. Methods 135 children who were admitted to our hospital from March 2015 to October 2017 and diagnosed with mycoplasmal pneumonia were selected. The patients were confirmed to be lung consolidation by X-ray or CT. Patients were randomized into a lavage group(n=68) and a control group(n=67). The control group was given symptomatic treatment against mycoplasma, and the lavage group was additionally treated with electronic bronchoscopy lavage. The preoperative fever time, hospital stay, mean duration of disease, and pulmonary imaging recovery of two groups were compared. Results The fever time, hospitalization time, average disease duration and lung imaging recovery in the lavage group were better than those in the control group. The total effective rate was100.0% in the lavage group and 83.6% in the control group. The difference was statistically significant(P<0.05). Conclusion In children with mycoplasmal pneumonia and pulmonary consolidation, electronic bronchoscopy lavage can improve clinical symptoms, shorten the course of disease, and promote lung recruitment, which is an effective method and worthy of clinical promotion.
Objective To explore the efficacy of electron bronchoscopy alveolar lavage in children with mycoplasmal pneumonia and pulmonary consolidation. Methods 135 children who were admitted to our hospital from March 2015 to October 2017 and diagnosed with mycoplasmal pneumonia were selected. The patients were confirmed to be lung consolidation by X-ray or CT. Patients were randomized into a lavage group(n=68) and a control group(n=67). The control group was given symptomatic treatment against mycoplasma, and the lavage group was additionally treated with electronic bronchoscopy lavage. The preoperative fever time, hospital stay, mean duration of disease, and pulmonary imaging recovery of two groups were compared. Results The fever time, hospitalization time, average disease duration and lung imaging recovery in the lavage group were better than those in the control group. The total effective rate was100.0% in the lavage group and 83.6% in the control group. The difference was statistically significant(P<0.05). Conclusion In children with mycoplasmal pneumonia and pulmonary consolidation, electronic bronchoscopy lavage can improve clinical symptoms, shorten the course of disease, and promote lung recruitment, which is an effective method and worthy of clinical promotion.
引文
[1]Xin D,Mi Z,Han X,et al.Molecular mechanisms of macrolide resistance in clinical isolates of mycoplasma pneumoniae from China[J].Antimicrob Agents Chemother,2009,53(5):2158-2159.
[2]赵顺英,马云,张桂芳,等.儿童重症肺炎支原体肺炎11例临床分析[J].中国实用儿科杂志,2003,18(7):414.
[3]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[4]王娟,孙军.纤维支气管镜肺泡灌洗术治疗儿童难治性支原体肺炎疗效分析[J].临床儿科杂志,2017,35(1):16-18.
[5]Kreutzer MF,Kage H,Herrmann J,et al.Precursor-directed biosynthesis of Micacocidin derivatives with activity against Mycoplasma pneumoniae[J].Organic&Biomolecular Chemistry,2014,12(1):113-118.
[6]赵顺英.肺炎支原体感染的临床表现和肺外并发症[J].实用儿科临床杂志,2007,22(4):249-250.
[7]Liu JR,Peng Y,Yang HM,et al.Clinical characteristics and predictive factors of refractory Mycoplasma pneumoniae pneumonia[J].Zhonghua Er Ke Za Zhi,2012,50(12):915-918.
[8]Medjo B,Atanaskovic-Markovic M,Radic S,et al.Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia in children:Clinical features and laboratory diagnosis[J].Ital J Pediatr,2014,40(1):104.
[9]燕民,彭建.小儿支原体肺炎发生闭塞性细支气管炎的高危因素临床分析[J].中国医药指南,2011,9(22):203-205.
[10]安淑华,张丽君,李金英.气道黏液栓形成的肺炎支原体肺炎患儿的预后分析[J].中国当代儿科杂志,2015,17(5):487-491.
[11]陈丽,蔡栩栩,尚云晓.小儿肺炎支原体肺炎高分辨率CT影像学特点[J].国际儿科杂志,2013,40(6):635-638.
[12]John SD,Ramanathan J,Swischuk LE.Spectrum of clinical and radiographic findings in pediatric Mycoplasma pneumonia[J].Radiographics,2001,21:121-131.
[13]Shah SS,Test M,Sheffler-Collins S,et al.Macrolide therapy and outcomes in a multicenter cohort of children hospitalized with Mvcoplasma pneumoniae pneumonia[J].J Hosp Med,2012,7(4):311-317.
[14]Okazaki N,Narita M,Yamada S,et al.Characteristics of macro-Lide resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitro[J].Microbiol Immunol,2001,45(8):617-620.
[15]Cao B,Zhao CJ,Yin YD,et al.High prevalence of macrolide resistance in mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China[J].Clin Infect Dis,2010,51(2):189-194.
[16]中华医学会儿科学分会呼吸学组儿科支气管镜协作组.儿科支气管镜术指南(2009年版)[J].中华儿科杂志,2009,47(10):740-744.
[17]袁壮,陆权.肺炎支原体肺炎的诊治[J].中国实用儿科杂志,2008,23(8):561-572.
[2]赵顺英,马云,张桂芳,等.儿童重症肺炎支原体肺炎11例临床分析[J].中国实用儿科杂志,2003,18(7):414.
[3]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[4]王娟,孙军.纤维支气管镜肺泡灌洗术治疗儿童难治性支原体肺炎疗效分析[J].临床儿科杂志,2017,35(1):16-18.
[5]Kreutzer MF,Kage H,Herrmann J,et al.Precursor-directed biosynthesis of Micacocidin derivatives with activity against Mycoplasma pneumoniae[J].Organic&Biomolecular Chemistry,2014,12(1):113-118.
[6]赵顺英.肺炎支原体感染的临床表现和肺外并发症[J].实用儿科临床杂志,2007,22(4):249-250.
[7]Liu JR,Peng Y,Yang HM,et al.Clinical characteristics and predictive factors of refractory Mycoplasma pneumoniae pneumonia[J].Zhonghua Er Ke Za Zhi,2012,50(12):915-918.
[8]Medjo B,Atanaskovic-Markovic M,Radic S,et al.Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia in children:Clinical features and laboratory diagnosis[J].Ital J Pediatr,2014,40(1):104.
[9]燕民,彭建.小儿支原体肺炎发生闭塞性细支气管炎的高危因素临床分析[J].中国医药指南,2011,9(22):203-205.
[10]安淑华,张丽君,李金英.气道黏液栓形成的肺炎支原体肺炎患儿的预后分析[J].中国当代儿科杂志,2015,17(5):487-491.
[11]陈丽,蔡栩栩,尚云晓.小儿肺炎支原体肺炎高分辨率CT影像学特点[J].国际儿科杂志,2013,40(6):635-638.
[12]John SD,Ramanathan J,Swischuk LE.Spectrum of clinical and radiographic findings in pediatric Mycoplasma pneumonia[J].Radiographics,2001,21:121-131.
[13]Shah SS,Test M,Sheffler-Collins S,et al.Macrolide therapy and outcomes in a multicenter cohort of children hospitalized with Mvcoplasma pneumoniae pneumonia[J].J Hosp Med,2012,7(4):311-317.
[14]Okazaki N,Narita M,Yamada S,et al.Characteristics of macro-Lide resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitro[J].Microbiol Immunol,2001,45(8):617-620.
[15]Cao B,Zhao CJ,Yin YD,et al.High prevalence of macrolide resistance in mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in China[J].Clin Infect Dis,2010,51(2):189-194.
[16]中华医学会儿科学分会呼吸学组儿科支气管镜协作组.儿科支气管镜术指南(2009年版)[J].中华儿科杂志,2009,47(10):740-744.
[17]袁壮,陆权.肺炎支原体肺炎的诊治[J].中国实用儿科杂志,2008,23(8):561-572.