纤支镜肺泡灌洗术局部应用阿奇霉素联合乙酰半胱氨酸治疗小儿重症肺炎疗效分析

目的 探讨通过纤支镜肺泡灌洗术局部应用阿奇霉素联合乙酰半胱氨酸治疗小儿重症肺炎的临床疗效及安全性.方法 选取自2018年9月至2020年6月海南医学院第二附属医院收治的144例重症肺炎患儿为研究对象,采用随机数字表法将患儿分为常规组与观察组,每组72例.常规组给予阿奇霉素注射液静滴3 d,而后改用阿奇霉素片口服;乙酰半...

Efficacy analysis of local application of azithromycin combined with acetylcysteine in treatment of severe pneumonia in children by bronohoalveolar lavage

Objective To investigate the clinical efficacy and safety of local application of azithromycin combined with acetylcysteine in the treatment of severe pneumonia in children by bronohoalveolar lavage(BAL).Methods A retrospective study was performed on 144 cases of sick children with severe pneumonia who were admitted from September 2018 to June 2020.Sick children were randomly divided into the conventional group and the observation group,with 72 cases in each group.The routine group of patients were given azithromycin injection intravenously for 3 days,and converted to oral azithromycin tablets,then acetylcysteine injection+normal saline aerosol inhalation was performed.The observation group of patients received BAL on the basis of conventional treatment,and local application of azithromycin combined with acetylcysteine was performed on the alveolar lavage at the lesion site.The time when the body temperature returned to normal,dyspnea disappeared,lung wet rales disappeared,clinical efficacy and the incidence of adverse reactions were recorded and compared between the two groups.Blood gas analysis indexes(arterial oxygen partial pressure,oxygen saturation,carbon dioxide partial pressure)and inflammatory indexes(tumor necrosis factorα,interleukin 6)were recorded and compared between two groups before and after treatment.Results The time of recovery of body temperature,disappearance of dyspnea and lung moist rale in the observation group were significantly shorter than those of the conventional group,and the differences were statistically significant(P<0.01).Before treatment,there was no statistically significant difference in the comparison of arterial oxygen partial pressure,oxygen saturation and carbon dioxide partial pressure between the two groups(P>0.05).After treatment,the partial pressure of arterial blood oxygen and oxygen saturation were increased and the partial pressure of carbon dioxide was reduced in both groups(P<0.05).The arterial oxygen partial pressure and oxygen saturation in the observation group were higher than those of the conventional group,and carbon dioxide content of the observation group was lower than that of the conventional group(P<0.05).Before treatment,there was no statistically significant difference in the comparison of tumor necrosis factorα,interleukin 6 between the two groups(P>0.05).After treatment,tumor necrosis factorα,interleukin 6 were reduced in both groups,and those in the observation group were lower than the conventional group(P<0.05).The total effective rate of the observation group was 91.7%(66/72),which was significantly higher than that of the conventional group(77.8%,56/72),P<0.05.The incidence of adverse reactions in the conventional group was 6.9%(5/72),while that in the observation group was 8.3%(6/72).There was no significant difference between the two groups(P>0.05).Conclusion Local BAL application of azithromycin combined with acetylcysteine in the treatment of severe pneumonia in children can significantly inhibit the inflammatory reaction,with significant clinical efficacy and safety.