梁永祺 蒋苏华 黄葆莹 陈晓倩

【摘要】 目的：探讨纤维支气管镜肺泡灌洗术（BAL）对重症肺炎患儿全身炎症及动脉血血气的影响。方法：对2019年4月-2020年1月本院收治的78例重症肺炎患儿的资料进行回顾性分析。按照是否接受BAL治疗将患儿分为观察组（n=42）和对照组（n=36）。对照組予以常规治疗，观察组予以常规治疗联合BAL治疗。于治疗前及治疗3 d后检测两组的血清炎症指标[降钙素原（PCT）、白细胞介素-6（IL-6）及C反应蛋白（CRP）]及动脉血血气指标[动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SpO2）、氧合指数（PaO2/FiO2）及血乳酸（Lac）]，比较两组临床疗效。结果：治疗3 d后，两组的血清PCT、IL-6及CRP水平均较治疗前明显降低（P<0.05），观察组的血清PCT、IL-6及CRP水平均明显低于对照组（P<0.05）。治疗3 d后，两组的PaCO2及Lac水平均较治疗前明显降低（P<0.05），PaO2、SpO2及PaO2/FiO2水平均较治疗前明显增高（P<0.05），观察组的PaCO2及Lac水平均明显低于对照组（P<0.05），PaO2、SpO2及PaO2/FiO2水平均明显高于对照组（P<0.05）。观察组的治疗总有效率明显高于对照组（P<0.05）。结论：纤维支气管镜肺泡灌洗术治疗重症肺炎可明显减轻患儿机体炎症反应，改善动脉血血气参数，利于提高临床疗效。

【关键词】 儿童 重症肺炎 纤维支气管镜 肺泡灌洗 全身炎症

[Abstract] Objective： To investigate the effect of fiberoptic bronchoscopic alveolar lavage （BAL） on systemic inflammatory and arterial blood gas in children with severe pneumonia. Method： The date of 78 children with severe pneumonia admitted to our hospital from April 2019 to January 2020 were retrospectively analyzed. According to whether to accept BAL treatment， the children were divided into observation group （n=42） and control group （n=36）. The control group was given conventional treatment， and the observation group was given conventional treatment combined with BAL. Serum inflammatory indexes [procalcitonin （PCT）， interleukin-6 （IL-6） and C-reactive protein （CRP）]and arterial blood gas indexes [arterial partial pressure of carbon dioxide （PaCO2）， arterial partial pressure of oxygen （PaO2）， arterial oxygen saturation （SpO2）， oxygenation index （PaO2/FiO2） and blood lactic acid （Lac）] were detected before and 3 d after treatment， and the clinical efficacy of two groups were compared. Result： After 3 d of treatment， the serum PCT， IL-6 and CRP levels of two groups were significantly lower than those of before treatment （P<0.05）， and the serum PCT， IL-6 and CRP levels of the observation group were significantly lower than those of the control group （P<0.05）. After 3 d of treatment， PaCO2 and Lac levels of two groups were significantly lower than those of before treatment （P<0.05）， PaO2， SpO2 and PaO2/FiO2 levels were significantly higher than those of before treatment （P<0.05）， PaCO2 and Lac levels of the observation group were significantly lower than those of the control group （P<0.05）， PaO2， SpO2 and PaO2/FiO2 levels were significantly higher than those of the control group （P<0.05）. The total effective rate of the observation group was significantly higher than that of the control group （P<0.05）. Conclusion： Fiberoptic bronchoscopic alveolar lavage in the treatment of severe pneumonia can significantly reduce the body inflammation， improve the parameters of arterial blood gas， and improve the clinical efficacy.

[Key words] Children Severe pneumonia Fiberoptic bronchoscopic Alveolar lavage Systemic inflammation

First-authors address： Foshan First Peoples Hospital， Foshan 528000， China

doi：10.3969/j.issn.1674-4985.2021.09.003

重症肺炎为临床儿科常见的危急重症，常合并肺外器官功能障碍，其临床治疗以抗感染、维持纠正水电解质平衡、祛痰、平喘等基础治疗为主[1]。由于该病临床治疗难度较大且病情进展迅速，严重威胁患儿的生命安全[2]。近年来，纤维支气管镜肺泡灌洗技术（bronchoalveolar lavage， BAL）因诊疗一体化、可重复操作、创伤小等特点，逐步被用于临床呼吸系统疾病的治疗[3-4]。通过纤维支气管镜可直接将抗生素注入肺内病灶，清除气道病原菌、炎性分泌物及痰栓等[5]。因此，为进一步探讨纤维支气管镜肺泡灌洗技术对重症肺炎患儿全身炎症反应及动脉血血气的影响，本研究对近年收治的重症肺炎患儿进行研究，现报道如下。

1 資料与方法

1.1 一般资料 对2019年4月-2020年1月本院收治的78例重症肺炎患儿的资料进行回顾性分析。……