电子支气管镜肺泡灌洗术治疗儿童大叶性肺炎的临床研究

Clinical research of electron bronchoscopic alveolar lavage in the treatment of children with lobar pneumonia

摘要

目的 探讨电子支气管镜肺泡灌洗术治疗儿童大叶性肺炎的镜下表现及临床效果。方法 回顾性分析2017年1月至2022年6月在空军军医大学第二附属医院儿科住院诊治的100例儿童大叶性肺炎患儿的临床资料.根据患儿的临床表现、查体资料、实验室检查及影像学检查结果,对患儿行电子支气管镜检查及肺泡灌洗术,检测肺泡灌洗液中的肺炎支原体(MP),将MP阳性患儿分为MP肺炎组(74例),MP阴性患儿分为非MP肺炎组(26例);对MP阳性者及时加用敏感抗生素治疗,通过临床症状、实验室检查、灌洗前后胸部CT及预后等情况,比较并分析两组患儿肺炎的临床特点。结果 MP肺炎组患儿白细胞计数为(7.5±3.3)×10⁹/L,明显低于非MP肺炎组的(11.4±7.2)×10⁹/L,经比较差异有统计学意义(t=2.654,P<0.05).在100例儿童大叶性肺炎患儿中,电子支气管镜下以支气管黏膜炎症为主要表现,其中管腔狭窄8例,黏膜充血44例,黏膜肥厚3例,脓性分泌物附着87例,脓栓堵塞管腔14例,其他表现7例;MP肺炎组的管腔狭窄、黏膜充血、黏膜肥厚、脓性分泌物附着、脓栓堵塞管腔的分布均高于非MP肺炎组,但差异均无统计学意义(P>0.05).MP肺炎组的肝功谷草转氨酶、α-羟丁酸脱氢酶均高于非MP肺炎组,MP肺炎组累及右肺炎症、左肺炎症、双肺炎症及合并胸腔积液的检出率均高于非MP肺炎组,但差异均无统计学意义(P>0.05);MP肺炎组与非MP肺炎组消化系统受累、神经系统受累、肾功能损害的分布差异均无统计学意义(P>0.05).肺泡灌洗液中细菌培养阳性率低,仅为9例(9.0%).MP肺炎组肺泡灌洗液培养阳性7例(9.5%,7/74),非MP肺炎组肺泡灌洗液培养阳性2例(7.7%,2/26).荧光定量聚合酶链式反应(FQ-PCR)法检测的MP阳性率(74例,74.0%)明显高于血清MP特异性抗体(MP-IgM)法检测的MP阳性率(2例,2.0%),经比较差异有统计学意义(χ²=107.000,P<0.05).MP肺炎组患儿的症状缓解时间、肺啰音消失时间、抗生素调整时间和住院时间均大于非MP肺炎组,但差异均无统计学意义(P>0.05)。结论 电子支气管镜肺泡灌洗术治疗儿童大叶性肺炎的临床疗效确切,对MP阳性者尽早应用敏感抗生素进行治疗有助于改善患儿的临床症状及预后,可积极指导临床用药,避免抗生素滥用,缩短住院时间.

Abstract

Objective To investigate the microscopic manifestation and clinical effect of electron bronchoscopic alveolar lavage in the treatment of children with lobar pneumonia. Methods A total of 100 cases of lobar pneumonia hospitalized in the Department of Pediatrics of the Second Affiliated Hospital of Air Force Medical University from January 2017 to June 2022 were retrospectively analyzed. Based on the children's clinical manifestations, physical examination findings, laboratory examination and imaging tests, children underwent electronic bronchoscopy and alveolar lavage. By detecting mycoplasma pneumoniae (MP) in the alveolar lavage fluid, the children were divided into the MP pneumonia group (74 cases) and the non-MP pneumonia group (26 cases). The MP-positive patients were given sensitive antibiotics in time. Clinical symptoms, laboratory findings, chest CT before and after lavage, and prognosis of the children were compared and analyzed to determine the clinical characteristics of pneumonia in the two groups of children. Results The white blood cell count of children in the MP pneumonia group with (7.5±3.3)×10⁹/L was significantly lower than that in the non-MP pneumonia group with (11.4±7.2)×10⁹/L, with a statistically significant difference (t=2.654, P<0.05); Among 100 cases of children with lobar pneumonia, bronchial mucosal inflammation was the main manifestation observed under electronic bronchoscopy. Specifically, there were 8 cases of bronchial stenosis, 44 cases of mucosal congestion, 3 cases of mucosal hypertrophy, 87 cases of purulent secretion adherence, 14 cases of purulent plug obstruction of the bronchial lumen, and 7 cases with other manifestations. The proportion of bronchial stenosis, mucosal congestion, mucosal hypertrophy, purulent secretion adherence, and purulent plug obstruction of the bronchial lumen in the MP pneumonia group was higher than that in the non-MP pneumonia group, and the difference was not statistically significant (P>0.05). The levels of aspartic transaminase (AST) and α-hydroxybutyrate dehydrogenase (α-HBDH) in the MP pneumonia group were higher than those in the non-MP pneumonia group. The detection rates of right lung inflammation, left lung inflammation, bilateral lung inflammation, and pleural effusion in the MP pneumonia group were all higher than those in the non-MP pneumonia group, but the differences were not statistically significant (P>0.05). There were no statistically significant differences in the distribution of digestive system involvement, neurological involvement, and renal function damage between the MP pneumonia group and the non-MP pneumonia group (P>0.05). The positive rate of bacterial culture in the alveolar lavage fluid was low, with only 9 cases (9.0%). In the MP pneumonia group, there were 7 cases of positive culture in the alveolar lavage fluid (9.5%, 7/74), while in the non-MP pneumonia group, there were 2 cases of positive culture (7.7%, 2/26). The positive rate of MP detected by fluorescence quantitative-polymerase chain reaction (FQ-PCR) method (74 cases, 74.0%) was significantly higher than that detected by serum MP-specific antibody (MP-IgM) method (2 cases, 2.0%), with a statistically significant difference (χ ²=107.000, P<0.05). The time for symptom relief, disappearance of pulmonary rales, adjustment of antibiotics, and length of hospital stay were all longer in the MP pneumonia group compared to the non-MP pneumonia group, but the differences were not statistically significant (P>0.05). Conclusion The clinical efficacy of electron bronchoscopic alveolar lavage for the treatment of lobar pneumonia in children is definite. Early administration of sensitive antibiotics to MP-positive patients helps improve clinical symptoms and prognosis, enabling proactive guidance on clinical medication, avoiding antibiotic misuse, and reducing hospitalization duration.

关键词

大叶性肺炎 / 儿童 / 电子支气管镜肺泡灌洗术 / 疗效评价 / 抗生素应用

Key words

lobar pneumonia / child / electron bronchoscopic alveolar lavage / efficacy evaluation / antibiotic application

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基金资助

国家自然科学基金资助(82372086)

空军军医大学军事医学“珠峰工程”(2020yyzt11)

唐都医院创新发展基金-临床研究项目(2018LCYJ003)