苏宇飞，常文毅，王　列，余宏川

(西安市儿童医院急诊科，陕西 西安 710003)



纤维支气管镜下支气管肺泡灌洗治疗儿童重症支原体肺炎的疗效探讨

苏宇飞，常文毅，王列，余宏川

(西安市儿童医院急诊科，陕西 西安 710003)

目的探讨纤维支气管镜(简称：纤支镜)下支气管肺泡灌洗术及沐舒坦、布地奈德支气管注药联合常规抗生素治疗儿童重症支原体肺炎(MPP)的临床疗效。方法选取2012年11月至2014年12月收治的107例重症MPP患儿，随机分为常规治疗组51例和纤支镜组56例。常规组患儿给予大环内脂类药物治疗，并予以退热、止咳、祛痰等对症治疗，必要时使用激素与免疫球蛋白；纤支镜组在常规组基础上使用纤支镜进行生理盐水支气管肺泡灌洗，及病变部位沐舒坦、布地奈德注药治疗。治疗7d后，检测外周血炎性因子水平，判定临床疗效，比较两组症状体征消失时间。结果治疗7d后，纤支镜组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hs-CPR)水平均显著低于常规组(U值分别为3.185、2.886、3.882，均P<0.05)。纤支镜组平均体温恢复时间、咳嗽消失时间、啰音消失时间、肺部X线恢复时间及住院时间均明显少于常规组，差异均具有统计学意义(U值分别为4.681、4.624、5.517、4.111、3.681，均P<0.05)。治疗7d内，纤支镜组转为有创通气比例为3.6%，低于常规组的13.7%，差异具有统计学意义(FisherP=0.083)。两组疗效构成无明显差异(Z=1.681，P=0.093)；纤支镜组总体有效率为94.6%，明显高于常规组的82.4%，差异具有统计学意义(χ2=4.049，P=0.044)。结论大环内脂类药物联合纤支镜肺泡灌洗及沐舒坦、布地奈德支气管注药治疗小儿重症MPP，可明显减轻炎性反应，显著缩短患儿症状体征消失时间，提高临床疗效。

纤维支气管镜；肺泡灌洗；沐舒坦；布地奈德；重症支原体肺炎；炎性因子

[Abstract]ObjectiveToexploretheclinicalefficacyofbronchoalveolarlavage(BAL),ambroxolandbudesonidebronchialinjectioncombiningconventionalantibioticsintreatmentofchildrenwithseveremycoplasmapneumoniaepneumonia(MPP).MethodsFromNovember2012toDecember2014 107severeMPPchildrenwereenrolledinstudyandwererandomlydividedintoroutinegroup(51cases)andBALgroup(56cases).Theroutinegroupwasgivenmacrolidedrugtreatment,andantipyretic,anti-coughandexpectoranttreatmentwasprovided.Hormoneandimmunoglobulinproteinweretakenifnecessary.Besidestreatmentfortheroutinegroup,BALgroupwasgivenBALtreatment,budesonideandambroxolbronchialinjectionatlesions.After7-daytreatmentperipheralbloodinflammatoryfactorswereexaminedandclinicalefficaciesweredetermined.Symptomsandsignsdisappearancetimeoftwogroupswerecompared.ResultsAfter7-daytreatment,peripheralbloodTNF-α,IL-6andhs-CRPlevelsinBALgroupweresignificantlylowerthantheroutinegroup(Uvaluewas3.185, 2.886and3.882,respectively,allP<0.05).InBALgroupaveragetemperaturerecoverytime,coughdisappearancetime,fadingtimeofcrackles,recoveryoflungX-rayandhospitalizationdayswereshorterwithsignificantdifferences(Uvaluewas4.681, 4.624, 5.517, 4.111and3.681,respectively,allP<0.05).Within7-daytreatment,BALgroupwithinvasiveventilationproportion(3.6%)wassignificantlylowerthantheroutinegroup(13.7%) (fisherP=0.083).Clinicalefficacyconstitutionsoftwogroupswerenotdifferentobviously(Z=1.681,P=0.093).TheoverallefficiencyofBALgroup(94.6%)wassignificantlyhigherthantheroutinegroup(82.4%) (χ2=4.049, P=0.044).ConclusionMacrolidescombiningBALtreatment,ambroxolandbudesonidebronchialinjectioncanreduceinflammatoryreaction,significantlyshortendisappearancetimeofsymptomsandsignsandimproveclinicalefficacyontreatmentofsevereMPP.

[Keywords]fiberopticbronchoscopy;bronchoalveolarlavage(BAL);ambroxol;budesonide;severemycoplasmapneumoniaepneumonia;inflammatoryfactor

肺炎支原体肺炎(mycoplasmapneumoniaepneumonia，MPP)是由肺炎支原体(mycoplasmapneumoniae，MP)感染引起的肺部急性炎症病变，约占小儿肺炎的10%～30%[1]。MPP发病机制中除MP对肺组织的直接侵袭外，免疫性炎性反应在疾病发生、发展中发挥重要作用，重症患儿出现胸腔积液、肺不张及肺坏死等严重并发症[2]。目前临床对MPP的治疗主要采用大环内酯类抗菌药，但随着临床抗菌药的不规范使用及细菌耐药性的逐年增长，抗菌药的治疗效果逐年降低[3]。……