床旁纤维支气管镜对重症肺炎感染指标及血气分析影响的分析研究  

Values of bedside flexible fiberoptic bronchoscopy in treatment of pediatric severe pneumonia on the Infection indexes and blood gas analysis in pediatric severe pneumonia

作　　者：袁远宏[1] 张慧[2] 肖政辉[1] 卢秀兰[1] 张新萍[1] 祝益民[1] 仇君[1] 蔡姿丽[1] 

机构地区：[1]湖南省儿童医院急救中心,长沙410007 [2]湖南省儿童医院肝病中心

出　　处：《中国急救复苏与灾害医学杂志》2018年第2期135-138,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：十二五国家科技支持项目：儿科应急救治相关技术的研究与推广应用（2012BAI04B01）;湖南省卫生厅课题：湖南省儿童脓毒症研究中心：（2013）6号.

摘　　要：目的探讨纤维支气管镜（简称纤支镜）在改善重症肺炎患儿感染指标及血气分析等疗效方面的作用和意义。方法回顾性选取2013年8月-2014年8月在湖南省儿童医院（pediatricintensivecareunit，P1CU）住院诊断为重症肺炎的299名已行纤支镜的患儿和收集了同期198例重症肺炎但家属拒绝行纤支镜的患儿为研究对象。对纤支镜介入前后感染指标及血气分析改变情况进行分析研究，并与对照组的感染指标进行对比，应用检验和Mann—WhitneyU检验对资料进行统计学分析。结果纤支镜介入前后血气分析上吸入氧浓度、PH值、动脉血氧分压、动脉二氧化碳分压、动脉血氧饱和度和乳酸（1actate，LAC）均得到不同程度的改善，差异有统计学意义（P〈0．05）；感染指标上白细胞、C-反应蛋白、降钙素原较治疗前均出现下降，经配对样本t检验差异有统计学意义（P〈0.05），与对照组比较C-反应蛋白、降钙素原明显降低，差异有统计学意义（P〈0．05）。结论纤支镜能改善重症肺炎患儿的感染指标及通气情况，有较好的临床应用价值，值得在重症肺炎患儿中推广应用。Objective To investigate the effects of bedside flexible fiberoptic bronchoscopy （FB） on the improvement of infection indexes and blood gas analysis in pediatric severe pneumonia. Methods 299 children with severe pneumonia, 216 male and 83 female, 94.97% being aged ltol2months, were hospitalized in the pediatric intensive care unit （PICU） and underwent bedside FB in addition to conventional treatment （FB Group）, and 198 severe pneumonia children without demography differencewhose parents refused to adopt bedside FB were admitted at the same period and treated only conventionally . Gas analysis was conducted before and 2-4 h after treatment. White blood count, C-reactive protein （CRP）, and procalcitonin （PCT） were measured before and 3-5 d after the treeatment. Results In the FB group, the fraction of inspiration 02 （FiO2）after treatment was 40%, significantly lower than that before treatment （29%, t= 2.67, P=0.009）; the pH after treatment was （7.44±0.06）, significantly higher than that before treatment [（7.41±0.08）, t= 2.67, P=0.009]; the arterial partial pressureof oxygen （PaO2）after treatment was （93.37±27.98）; significantly higher than that before treatment [（84.93±30.18）, t=-2.55,P=0.012]; the arterial oxygen saturation （SaO：） after treatment was （96.90±2.77）, signifieantly higher than that before treatment [（94.30±6.36）, t=-4.09, P〈0.001]; the arterial partial pressure of carbondioxide（PaCO2） after treatment was （39.33± 10.53）, significantly lower than that before treatment [（54.62 ± 9.91）, t=2.28, P〈0.00]; and the blood lactic acid level （LAC） after treatment was （0.92 ＋ 0.51） mmol/L , significantly lower than that before treatment [（1.35±1.29） mmol/L, t=3.93, P〈0.001]. The WBC count after treatment was （9.01±4.92）×109/L, significantly lower than that bebore treatment [（10.59±7.24）×109/L, t=-3.70, P〈0.001]; the CRP alter treatment was 6.26±16.59, significantly lower than that before treatme

关 键 词：纤维支气管镜 感染指标 重症肺炎 儿童 

分 类 号：R563.1[医药卫生—呼吸系统]