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

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。

Effects of Bronchoalveolar Lavage by Bronchofibroscope on Bacterial Clearance Rate and Disease Progression in Children with Severe Pneumonia

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.