支气管肺泡灌洗在重症肺炎患儿中的应用价值  

Value of application of bronchoalveolar lavage in children with severe pneumonia

作　　者：施弦[1] 管敏昌 孙杰[1] 汤卫红 郁峰[1] 杭金国 王惠庭 

机构地区：[1]湖州市中心医院儿科,浙江湖州313000 [2]台州恩泽医疗中心路桥医院儿科,浙江台州318050

出　　处：《中华医院感染学杂志》2014年第6期1531-1533,共3页Chinese Journal of Nosocomiology

基　　金：台州市科技局基金资助项目(11ky34)

摘　　要：目的探讨支气管肺泡灌洗(BAL)在重症肺炎患儿中的应用价值,以指导临床选择有效抗菌药物。方法选择医院PICU重症肺炎患儿126例,按就诊顺序随机分为对照组和观察组各63例,对照组留取深部痰液送细菌培养,观察组给予BAL,采集支气管肺泡灌洗液(BALF)采用法国生物梅里埃公司VITEK测试系统进行细菌鉴定及药敏测定;对两种标本的培养阳性率进行比较,并根据药敏结果选择相应的抗菌药物,4周后观察治疗效果,用SPSS 16.0软件进行统计分析。结果痰液培养阳性率为49.2%,BALF培养阳性率为68.3%;对照组住院(18.44±3.80)d、发热(10.27±4.11)d、使用抗菌药物退热(9.13±4.12)d、肺部体征消失时间(11.06±3.94)d,观察组分别为(14.33±3.56)d、(7.29±4.17)d、(5.43±3.43)d、(6.33±2.97)d;对照组治疗总有效率69.8%,观察组总有效率88.9%,两组比较均差异有统计学意义(P<0.01)。结论 BALF直接取材于病变部位,培养阳性率高,可更好地指导临床选择有效抗菌药物,同时BAL可促使肺泡液排出,有利于炎症吸收,对重症肺炎的恢复有意义。OBJECTIVE To explore the value of application of bronchoalveolar lavage （BAL） in children with severe pneumonia so as to provide guidance for clinical use of antibiotics. METHODS A total of 126 children with severe pneumonia in PICU were enrolled in the study and randomly divided into the control group and the observation group according to the order of visit, with 63 cases in each, then the deep sputum specimens were sampled for bacterial culture, the observation group was treated with BAL, the bronchoalveolar lavage fluid （BALF） was sampled,the bacterial identification was performed by using VITEK test system of BioMorieux, France, the drug susceptibility testing was carried out, the positive rates of culture of two specimens were compared, the antibiotics were used on the basis of result of the drug susceptibility testing, the clinical symptoms were observed 4 weeks after treatment, the therapeutic effect was evaluated, and the statistical analysis was performed with the use of SPSS 16.0 software. RESULTS The positive rate of sputum culture was 49. 2% in the control group, and the positive rate of BALF culture was 68.3% in the observation group, with statistical significance. The mean hospitalization duration was （18.44±3.80）days in the control group, （14.33±3.56）days in the observation group; the mean fever time was （10.27±4. 11）days in the control group, （7.29±4.17）days in the observation group; the defervescence time after therapy was （9.13±4.12） days in the control group, （5.4.3±3.43）days in the observation group; the extinction time of physical sign was （11.06±3.94） days in the control group, （6.33±2.97）days in the observation group. The total effective rate was 69. 8% in the control group, 88. 9% in the observation group （P〈0.01）. CONCLUSION The BALF is directly sampled from the lesion site, and the positive rate of culture is high, which may guide the clinical use of antibiotics; the BAL can facilitate the excretion of alveolar fluid and the inf

关 键 词：重症肺炎 患儿 支气管肺泡灌洗 细菌培养 

分 类 号：R563.1[医药卫生—呼吸系统]