刘清彪+罗慧嫦+许柏华+李诗宇+张宇玲

[摘要]目的 探討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应用价值。方法 选取我院2015年1月～2016年12月住院儿童经X线胸片、CT及实验室指标证实为重症支原体肺炎100例作为研究对象，且经纤维支气管镜除外异物、畸形、肿瘤、结核等，明确为感染所致。根据治疗方法不同分为两组，观察组和常规组各50例。常规组用呼吸机辅助呼吸、抗感染、营养支持及对症治疗，观察组行床旁纤维支气管镜吸痰、灌洗、注药治疗。观察两组的疗效、安全性。结果 观察组治疗有效率为96.0%，对照组治疗有效率为76.0%，差异有统计学意义（P<0.05）；在咳嗽、胸疼、肺部啰音、肺部X线吸收时间比较，观察组较对照组明显缩短，差异有统计学意义（P<0.01）；观察组发生并发症2例，并发症发生率为4.0%，鼻出血及术后发热各1例，给予对症治疗后明显改善、好转。对照组无并发症发生，两组并发症发生率比较差异无统计学意义（P>0.05）。结论 纤维支气管镜下支气管肺泡灌洗对小儿重症支原体肺炎有明显的治疗作用，且安全、有效。

[关键词]纤维支气管镜；支气管肺泡灌洗；儿童；重症支原体肺炎

[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-4721（2017）09（a）-0107-03

Effect observation on bronchoalveolar lavage in the treatment of severe Mycoplasma pneumonia in children under fiber bronchoscope

LIU Qing-biao1 LUO Hui-chang2 XU Bo-hua1 LI Shi-yu1 ZHANG Yu-ling1

1.Department of Pediatrics，the Donghua Hospital Affiliated to Sun Yat-sen University，Guangdong Province，Dongguan 523110，China；2.Department of Hemodialysis Room，the Donghua Hospital Affiliated to Sun Yat-sen University，Guangdong Province，Dongguan 523110，China

[Abstract]Objective To explore the application value of bronchoalveolar lavage in the treatment of severe Mycoplasma pneumonia in children under fiber bronchoscope.Methods A total of 100 pediatric patients who were diagnosed with severe Mycoplasmal pneumonia by X-ray，CT and laboratory indicators in our hospital from January 2015 to December 2016 were selected as research objects.The etiology was exclusively due to inflammation by fiber bronchoscope ruling out of foreign substance，deformity，tumor，and nodule.According to different therapeutic methods，they were divided into two groups.Regular applications of ventilator-assisted respiration，anti-infection，nutritional support，and symptomatic treatment were provided in both groups.In observation group（n=50），bedside sputum suction by fiber bronchoscope，lavage，and drug injection were provided，while in control group（n=50），sputum suction tube and humidifying for treatment were adopted.The effect and safety in the two groups were observed.Results The therapeutic effective rate was 96.0% in the observation group and 76.0% in the control group，with a statistical difference between the two groups （P<0.05）.In comparison with the cough，chest pain，lung rale，and time of X-ray absorption in the lung，those in the observation group were much shorter than those in the control group，which were displayed statistical differences（P<0.01）.In the observation group，2 cases were occurred with the complications，including 1 case of nasal bleeding and 1 case of postoperative fever，accounting for 4.0% in all.The complications were improved after symptomatic treatment.No complications occurred in the control group，which was not displayed a statistical difference after comparison.Conclusion Under fiber bronchoscope，bronchoalveolar lavage has a remarkable effect on severe mycoplasma pneumonia in children，which is safe and effective.endprint

[Key words]Fiber bronchoscope；Bronchoalveolar lavage；Children；Severe Mycoplasma pneumonia

近年来，儿童支原体肺炎发病年龄呈小龄化，感染率呈直线上升，且发病隐匿、症状不典型、病程长[1]，儿童支原体肺炎可导致患儿出现肺部病变，甚至心肌炎等器质性病变[2]，严重危害患儿健康。建立人工气道，进行机械通气是抢救重症肺炎并呼吸衰竭的重要手段。但在治疗过程中往往会因气道内分泌物及痰痂的堵塞影响机械通气的效果。解除呼吸道阻塞，保持呼吸道通畅是提高儿童重症肺炎抢救成功率的关键。给予经支气管镜行支气管肺泡灌洗（bronchoalveolar lavage，BAL）能提高儿童支原体肺炎治疗成功率。本研究旨在分析纤维支气管镜在儿童重症支原体肺炎的诊断及治疗价值，现报道如下。……