支氣管鏡檢查及肺泡灌洗術(shù)治療兒童重癥肺炎的臨床研究

黃光舉 張慧玉 田玲 陳娜 吳小磊

[摘要] 目的 探討支氣管鏡檢查及肺泡灌洗術(shù)在治療兒童重癥肺炎中的臨床價值。 方法 將該院200例隨機(jī)分成觀察組和對照組各100例，對照組使用常規(guī)病原檢測方法及常規(guī)治療方法，觀察組行支氣管鏡檢查及肺泡灌洗術(shù)進(jìn)行肺泡灌洗液收集及灌洗治療，比較兩組病原檢出率、治療效果和不良反應(yīng)，以評價支氣管鏡檢查及肺泡灌洗術(shù)在治療重癥肺炎中的臨床價值。 結(jié)果 觀察組肺泡灌洗液培養(yǎng)檢測率65%，而對照組痰培養(yǎng)檢測率52%；觀察組支原體PCR陽性率42%，對照組肺炎支原體抗體陽性率31%，兩者差異有統(tǒng)計學(xué)意義（P<0.05）；觀察組治療總有效率99%（99/100），顯著高于對照組治療總有效率82%（82/100），兩組臨床療效組間比較差異有統(tǒng)計學(xué)意義；兩組患兒均未無嚴(yán)重不良反應(yīng)發(fā)生。 結(jié)論 雖然支氣管鏡檢查及肺泡灌洗術(shù)容易引起輕微的不良反應(yīng)，但是相比于常規(guī)的痰培養(yǎng)或血清肺炎支原體抗體檢測，肺泡灌洗液培養(yǎng)、肺泡灌洗液PCR檢測率明顯增高，且治療效果明顯提高，故根據(jù)患兒體質(zhì)、病情等情況，值得推廣使用。

[關(guān)鍵詞] 支氣管鏡檢查；肺泡灌洗；重癥肺炎；病原檢出率

[中圖分類號] R59 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-0742（2015）05（b）-0030-02

Clinical Study of Bronchoscopy and Bronchoalveolar Lavage for Treatment of Severe Pneumonia in Children

HUANG Guang-ju，ZHANG Hui-yu，TIAN Ling，CHEN Na，WU Xiao-lei

CH Hospital of Tangshan City， Tangshang， Hebing Province， 063000 China

[Abstract] Objective To discuss the clinical value of fiberoptic bronchoscopy and bronchoalveolar lavage in treatment of severe pneumonia in children. Methods 200 cases were randomly divided into observation group and control group with 100 cases in each group. Conventional pathogen detection method and conventional treatment were performed in the control group， while bronchoscopy and bronchoalveolar lavage were used in the observation group for collection of bronchoalveolar lavage fluid and lavage treatment， additionally. Pathogen detection rate， curative effect and adverse reaction were compared between the two groups； the clinical value of fiberoptic bronchoscopy and bronchoalveolar lavage in the treatment of severe pneumonia was discussed. Results The detection rate of cultivation of bronchoalveolar lavage fluid and PCR positive rate of mycoplasma in the observation group were 65% and 52%，respectively，while cultivation detection rate of Sputum and mycoplasma pneumoniae antibodies positive rate in the control group were 42% and 31%，respectively， the differences were of statistically significant（P<0.05）；total effective rate，99%（99/100），of the observation group was significantly higher than that ，82%（82/100），of the control group， and the difference was of statistically significant； no severe adverse reactions were found in the two groups. Conclusion With slight adverse reaction， fiberoptic bronchoscopy and bronchoalveolar lavage can obviously improve the cultivation detection rate and PCR detection rate of bronchoalveolar lavage fluid which the routine detection of Sputum cultivation and antibodies to mycoplasma pneumoniae in human serum can not do， so it worth popularizing.

[Key words] Bronchoscopy； Bronchoalveolar lavage； Severe pneumonia； Pathogen detection rate

重癥肺炎是兒童兒科疾病中的常見病，患兒的臨床癥狀、體征缺乏不典型，容易出現(xiàn)誤診漏診情況，加上由于患兒年齡較小，其機(jī)體自身免疫防御系統(tǒng)較差，容易誘發(fā)其他多種并發(fā)癥，諸如心力衰竭、呼吸衰竭、中毒性腦病等，嚴(yán)重者可能危及患兒生命[1]。傳統(tǒng)病原檢測及常規(guī)的治療方法難以達(dá)到效果；隨著支氣管鏡在臨床中的應(yīng)用，對兒童重癥肺炎的診治取得了很大的進(jìn)步，為探討支氣管鏡檢查及肺泡灌洗術(shù)在治療兒童重癥肺炎中的臨床價值。該院2008年12月—2014年9月間通過支氣管鏡檢查及肺泡灌洗術(shù)輔助治療重癥肺炎，取得了較好的效果，現(xiàn)報道如下。

1 資料與方法

1.1 一般資料

隨機(jī)選擇于該院住院的兒童重癥肺炎患兒共200例，病例納入標(biāo)準(zhǔn)：均符合2002年英國胸科學(xué)會（British Thoracic Society，BTS）對重癥肺炎患兒的診斷標(biāo)準(zhǔn)[2]。……