纤维支气管镜肺泡灌洗术对重症肺炎患儿痰细菌清除率和病情进展的影响
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摘要
目的:探讨纤维支气管镜肺泡灌洗术对重症肺炎患儿痰细菌清除率及病情进展的影响。方法:回顾性分析我院儿科重症监护病房2014年12月至2017年6月收治的218例重症肺炎患儿病例资料,根据是否采用纤维支气管镜肺泡灌洗术治疗分为治疗组130例和对照组88例。对照组给予抗感染等常规治疗,治疗组在常规治疗基础上采用纤维支气管镜肺泡灌洗治疗,治疗2周后比较两组患儿痰培养结果、痰细菌清除率、临床症状体征、血清学感染指标变化情况及血气分析结果。结果:治疗后,治疗组痰细菌培养阳性率为61. 54%,高于对照组的28. 41%(P<0. 05);治疗组痰细菌清除率为77. 50%,明显高于对照组的52. 00%(P<0. 05)。与对照组比较,治疗组患儿治疗后发热、咳嗽、气促、喘息等临床症状缓解率更高、持续时间明显缩短,肺部啰音及肺不张等明显改善,血清学感染指标白细胞计数、中性粒细胞百分比、C反应蛋白、降钙素原水平等明显降低,患儿血气分析结果显示血氧饱和度、动脉血氧分压、氧合指数明显好转,差异均有统计学意义(P<0. 05)。结论:纤维支气管镜肺泡灌洗可安全地应用于重症肺炎患儿,有助于提高痰细菌培养阳性率从而指导早期精准治疗,提高痰细菌清除率,改善患儿临床症状,缩短病程及住院时间。
Objective: To probe into the effects of bronchoalveolar lavage by bronchofibroscope on bacterial clearance rate and disease progression in children with severe pneumonia. Methods: The clinical data of 218 children with severe pneumonia at pediatric intensive care unit of our hospital from Dec. 2014 to Jun. 2017 were retrospectively analyzed. According to whether or not bronchoalveolar lavage was performed,all children were divided into the treatment group( n = 130) and the control group( n = 88). The control group was given routine treatment of anti-infection,while the observation group additionally received bronchoalveolar lavage by bronchofibroscope based on the routine treatment. After 2 weeks of treatment,the sputum culture,sputum bacterial clearance rate,clinical signs and symptoms,serological infection indicators and blood gas analysis of two groups were compared. Results: After treatment,the positive rate of bacterial culture in the treatment group was 61. 54%,significantly higher than 28. 41% in the control group( P< 0. 05). The bacterial clearance rate of the treatment group was 77. 50%,significantly higher than 52. 00% of the control group( P< 0. 05). After treatment,compared with the control group,the relief rate of fever,cough,shortness of breath and breathing was higher,the duration was shorter,lung rales and atelectasis were significantly improved,the erological signs of white blood cells count,percentage of neutrophil,C-reactive protein,procalcitonin were significantly reduced,blood gas analysis showed blood oxygen saturation,arterial oxygen partial pressure,oxygenation index were improved significantly,the differences were statistically significant( P < 0. 05). Conclusion: Bronchoalveolar lavage by bronchofibroscope can be safely applied to children with severe pneumonia,which can increase the positive rate of sputum culture and guide early precision treatment,improve the clearance rate of sputum bacteria,improve the clinical symptoms of children,shorten the course of disease and the length of stay.
Objective: To probe into the effects of bronchoalveolar lavage by bronchofibroscope on bacterial clearance rate and disease progression in children with severe pneumonia. Methods: The clinical data of 218 children with severe pneumonia at pediatric intensive care unit of our hospital from Dec. 2014 to Jun. 2017 were retrospectively analyzed. According to whether or not bronchoalveolar lavage was performed,all children were divided into the treatment group( n = 130) and the control group( n = 88). The control group was given routine treatment of anti-infection,while the observation group additionally received bronchoalveolar lavage by bronchofibroscope based on the routine treatment. After 2 weeks of treatment,the sputum culture,sputum bacterial clearance rate,clinical signs and symptoms,serological infection indicators and blood gas analysis of two groups were compared. Results: After treatment,the positive rate of bacterial culture in the treatment group was 61. 54%,significantly higher than 28. 41% in the control group( P< 0. 05). The bacterial clearance rate of the treatment group was 77. 50%,significantly higher than 52. 00% of the control group( P< 0. 05). After treatment,compared with the control group,the relief rate of fever,cough,shortness of breath and breathing was higher,the duration was shorter,lung rales and atelectasis were significantly improved,the erological signs of white blood cells count,percentage of neutrophil,C-reactive protein,procalcitonin were significantly reduced,blood gas analysis showed blood oxygen saturation,arterial oxygen partial pressure,oxygenation index were improved significantly,the differences were statistically significant( P < 0. 05). Conclusion: Bronchoalveolar lavage by bronchofibroscope can be safely applied to children with severe pneumonia,which can increase the positive rate of sputum culture and guide early precision treatment,improve the clearance rate of sputum bacteria,improve the clinical symptoms of children,shorten the course of disease and the length of stay.
引文
[1]王静,程玮,张雯,等.重症肺炎患儿感染病原菌分布及其对肺功能的影响研究[J].中华医院感染学杂志,2016,26(15):3562-3563.
[2]范江花,张新萍,胥志跃,等.纤维支气管镜检查和肺泡灌洗术在重症肺部感染中应用意义[J].中国小儿急救医学,2015,22(7):449-453.
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[5]甄清,张冲林,苏建忠,等.纤支镜及支气管肺泡灌洗术在儿童迁延性肺炎的临床应用[J].临床肺科杂志,2015,20(10):1904-1906.
[6]MCMULLAN D M. Clinical management of pediatric tracheobronchmalacia[J]. Pediatr Crit Care Med,2011,12(5):599-600.
[7]刘淑华,申月波,刘翠青,等.纤维支气管镜肺泡灌洗术治疗新生儿肺不张的效果及安全性[J].中华围产医学杂志,2015,18(12):916-920.
[8]包宁,甘露.经纤维支气管镜肺泡灌洗加局部用药治疗危重病人肺部感染的疗效观察[J].临床肺科杂志,2012,17(7):1200-1202.
[9]陈大平.经纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染治疗中的临床作用[J].中华医院感染学杂志,2011,21(16):3355-3356.
[10]张海琼.下呼吸道感染患儿支气管肺泡灌洗液病原菌分布及耐药性分析[J].儿科药学杂志,2017,23(5):39-42.
[11]敖勇.纤维支气管镜肺泡灌洗对重症肺炎伴呼吸衰竭患者呼吸功能及炎症活动的影响[J].宁夏医科大学学报,2016,38(3):310-313.
[12]杨璐萍.发热期重症肺炎患儿纤维支气管镜灌洗治疗效果分析[J].医学综述,2016,22(13):2649-2652.
[13]于珊玲,刘菲菲,刘丰遂,等.支气管镜肺泡灌洗在重症肺部感染应用及灌洗液培养结果分析[J].临床肺科杂志,2017,22(10):1750-1753.
[14]陈晨松,李雪儿,黄夏亚.纤维支气管镜肺泡灌洗联合莫西沙星治疗重症肺部感染的疗效观察[J].实用药物与临床,2014,17(2):196-199.
[15]潘志伟,林业辉,文永钊.支气管肺泡灌洗术对儿童重症肺炎的临床疗效分析[J].儿科药学杂志,2018,24(7):28-30.
[2]范江花,张新萍,胥志跃,等.纤维支气管镜检查和肺泡灌洗术在重症肺部感染中应用意义[J].中国小儿急救医学,2015,22(7):449-453.
[3]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.
[4]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.
[5]甄清,张冲林,苏建忠,等.纤支镜及支气管肺泡灌洗术在儿童迁延性肺炎的临床应用[J].临床肺科杂志,2015,20(10):1904-1906.
[6]MCMULLAN D M. Clinical management of pediatric tracheobronchmalacia[J]. Pediatr Crit Care Med,2011,12(5):599-600.
[7]刘淑华,申月波,刘翠青,等.纤维支气管镜肺泡灌洗术治疗新生儿肺不张的效果及安全性[J].中华围产医学杂志,2015,18(12):916-920.
[8]包宁,甘露.经纤维支气管镜肺泡灌洗加局部用药治疗危重病人肺部感染的疗效观察[J].临床肺科杂志,2012,17(7):1200-1202.
[9]陈大平.经纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染治疗中的临床作用[J].中华医院感染学杂志,2011,21(16):3355-3356.
[10]张海琼.下呼吸道感染患儿支气管肺泡灌洗液病原菌分布及耐药性分析[J].儿科药学杂志,2017,23(5):39-42.
[11]敖勇.纤维支气管镜肺泡灌洗对重症肺炎伴呼吸衰竭患者呼吸功能及炎症活动的影响[J].宁夏医科大学学报,2016,38(3):310-313.
[12]杨璐萍.发热期重症肺炎患儿纤维支气管镜灌洗治疗效果分析[J].医学综述,2016,22(13):2649-2652.
[13]于珊玲,刘菲菲,刘丰遂,等.支气管镜肺泡灌洗在重症肺部感染应用及灌洗液培养结果分析[J].临床肺科杂志,2017,22(10):1750-1753.
[14]陈晨松,李雪儿,黄夏亚.纤维支气管镜肺泡灌洗联合莫西沙星治疗重症肺部感染的疗效观察[J].实用药物与临床,2014,17(2):196-199.
[15]潘志伟,林业辉,文永钊.支气管肺泡灌洗术对儿童重症肺炎的临床疗效分析[J].儿科药学杂志,2018,24(7):28-30.