乙酰半胱氨酸联合甲泼尼龙琥珀酸钠、纤维支气管镜肺泡灌洗治疗重症支原体肺炎患儿的临床研究

Clinical study on N-acetylcysteine combined with methylprednisolone sodium succinate and fiberoptic bronchoscopy with bronchoalveolar lavage for severe Mycoplasma pneumoniae pneumonia in children

摘要

目的 探讨乙酰半胱氨酸联合甲泼尼龙琥珀酸钠、纤维支气管镜肺泡灌洗(BAL)治疗重症支原体肺炎(SMPP)患儿的临床效果。方法 选取2022年7月至2023年12月沧州市中心医院收治的106例SMPP患儿为研究对象,根据治疗方式的不同分成对照组(n=54,应用甲泼尼龙琥珀酸钠、BAL治疗)和研究组(n=52,在对照组基础上联合乙酰半胱氨酸治疗)。比较两组疗效、症状缓解时间、肺功能指标[用力肺活量(FVC)、最大呼气峰流速(PEF)、最大呼气中段流量(MMF)]、炎症指标[白细胞介素-6(IL-6)、降钙素原(PCT)及γ干扰素(IFN-γ)]、血气指标[动脉血氧分压(PaO₂)、二氧化碳分压(PaCO₂)]及药物不良反应(ADR)发生情况。结果 研究组患儿总有效率高于对照组,差异有统计学意义(94.23% vs.79.63%,χ²=4.927,P<0.05);研究组咳嗽消失、退热、咽痛消失及啰音消失时间均短于对照组,差异有统计学意义(t值介于5.006~7.551之间,P<0.05);治疗后研究组FVC、PEF、MMF均高于对照组,差异有统计学意义(t值介于2.895~3.343之间,P<0.05);治疗后研究组IL-6、PCT、IFN-γ均低于对照组(t值介于6.357~6.927之间,P<0.05);治疗后研究组PaO₂高于对照组,PaCO₂低于对照组(t值分别为5.799、5.453,P<0.05);两组ADR发生率比较差异无统计学意义(P>0.05)。结论 对重症支原体肺炎患儿实施乙酰半胱氨酸联合甲泼尼龙琥珀酸钠、纤维支气管镜肺泡灌洗治疗的效果较佳,可有效改善炎症、血气指标,明显缩短症状缓解时间,显著提高肺功能。

Abstract

Objective To investigate the clinical efficacy of N-acetylcysteine combined with methylprednisolone sodium succinate and bronchofibroscope bronchoalveolar lavage(BAL) in children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods A retrospective analysis was conducted on the data of 106 children with SMPP from July 2022 to December 2023.Based on different treatment methods,they were grouped into control group (n=54,received methylprednisolone sodium succinate combined with BAL) and study group (n=52,adopted acetylcysteine received additional N-acetylcysteine treatment).The efficacy,symptom relief time,lung function indicators[forced vital capacity (FVC),peak expiratory flow (PEF),maximal mid-expiratory flow (MMF)],inflammatory indicators[interleukin-6 (IL-6),procalcitonin (PCT),and interferon-γ (IFN-γ)],blood gas indicators[arterial partial pressure of oxygen (PaO₂),partial pressure of carbon dioxide (PaCO₂)],and adverse drug reaction (ADR) were compared. Results The total effective rate of the test group was higher than that of the control group,with statistically significant difference (94.23% vs. 79.63%,χ ² = 4.927,P <0.05).The time for cough disappearance,fever reduction,sore throat disappearance,and rales disappearance in the test group was shorter than those in the control group,with statistically significant difference (t values ranged from 5.006 to 7.551,P<0.05).After treatment,the FVC,PEF,and MMF in the test group were higher than those in the control group,with statistically significant difference (t values ranged from 2.895 to 3.343,P<0.05).After treatment,the IL-6,PCT,and IFN-γ in the test group were lower than those in the control group,with statistically significant difference (t values ranged from 6.357 to 6.927,P<0.05).After treatment,the PaO ₂ in the test group was higher than that in the control group,while the PaCO₂ was lower,with statistically significant difference (t values were 5.799 and 5.453 respectively,P<0.05).There was no significant difference in ADR incidence between the two groups (P>0.05). Conclusion N-acetylcysteine combined with methylprednisolone sodium succinate and fiberoptic bronchoscopy-assisted bronchoalveolar lavage showed good clinical efficacy in children with severe Mycoplasma pneumoniae pneumonia.It effectively improved inflammatory and blood gas indicators,significantly shortened symptom relief time,and significantly improved lung function.

关键词

儿童 / 重症支原体肺炎 / 乙酰半胱氨酸 / 甲泼尼龙琥珀酸钠 / 纤维支气管镜肺泡灌洗

Key words

child / severe Mycoplasma pneumoniae pneumonia / N-acetylcysteine / methylprednisolone sodium succinate / bronchofibroscope bronchoalveolar lavage

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基金资助

河北省卫生健康委项目资助(20241740)