体外循环下先天性心脏病矫治术联合经纤维支气管镜支气管肺泡灌洗术治疗小儿先天性心脏病并重症肺炎的临床效果  

Clinical Effect of Surgical Rectifying of Congenital Heart Disease under Extracorporeal Circulation Combined with Bronchoalveolar Lavage via Fiberoptic Bronchoscopy in Treating Congenital Heart Disease Children Complicated with Severe Pneumonia

作　　者：彭效芹 甄清 PENG Xiaoqin;ZHEN Qing(Department of Respiratory Medicine,Xuzhou Children's Hospital Affiliated to Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属徐州儿童医院呼吸科

出　　处：《实用心脑肺血管病杂志》2019年第12期102-106,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨体外循环下先天性心脏病矫治术联合经纤维支气管镜支气管肺泡灌洗术治疗小儿先天性心脏病并重症肺炎的临床效果。方法选取2016年1月-2019年1月徐州医科大学附属徐州儿童医院收治的先天性心脏病并重症肺炎患儿68例,采用随机数字表法分为对照组和观察组,每组34例。在常规对症治疗基础上,对照组患儿行体外循环下先天性心脏病矫治术,观察组患儿在对照组基础上行经纤维支气管镜支气管肺泡灌洗术。比较两组患儿临床效果,治疗前及治疗15 d后氧合指数(OI)及呼吸力学参数[包括气道峰压(PIP)、肺动态顺应性(CLdyn)、气道阻力(Raw)及呼吸做功(WOB)],治疗前痰菌培养阳性率及治疗15 d后痰菌培养转阴率,实验室检查指标[包括降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)]恢复正常时间、体外循环时间及阻断时间、机械通气时间、抗生素使用时间、重症监护病房(ICU)入住时间,并记录两组患儿术后并发症发生情况。结果 (1)两组患儿均成功完成手术,观察组患儿临床效果优于对照组(P<0.05)。(2)两组患儿治疗前OI、PIP、CLdyn、Raw及WOB比较,差异无统计学意义(P>0.05);观察组患儿治疗15 d后OI、CLdyn高于对照组,PIP、Raw及WOB低于对照组(P<0.05)。(3)观察组患儿治疗前痰菌培养阳性率、治疗15 d后痰菌培养转阴率高于对照组(P<0.05)。(4)观察组患儿PCT、CRP、WBC恢复正常时间及机械通气时间、抗生素使用时间、ICU入住时间短于对照组(P<0.05);两组患儿体外循环时间及阻断时间比较,差异无统计学意义(P>0.05)。(5)观察组患儿术后出现黏膜出血2例,肺不张2例。结论体外循环下先天性心脏病矫治术联合经纤维支气管镜支气管肺泡灌洗术治疗小儿先天性心脏病并重症肺炎的临床效果确切,可有效改善患儿呼吸功能,促进痰菌转阴,缩短治疗时间,且安全性较高。Objective To investigate the clinical effect of surgical rectifying of congenital heart disease under extracorporeal circulation combined with bronchoalveolar lavage via fiberoptic bronchoscopy in treating congenital heart disease children complicated with severe pneumonia. Methods A total of 68 congenital heart disease children complicated with severe pneumonia were selected in Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University From January 2016 to January 2019,and they were divided into control group and observation group according to random number table method,with 34 cases in each group. Children in control group underwent surgical rectifying of congenital heart disease under extracorporeal circulation based on conventional symptomatic treatment,while children in observation group underwent extra bronchoalveolar lavage via fiberoptic bronchoscopy based on that of control group. Clinical effect,OI and respiratory mechanical parameter(including PIP,CLdyn,Raw and WOB)before treatment and 15 days after treatment,positive rate of sputum bacteria cultivation before treatment and negative conversion rate of sputum bacteria cultivation 15 days after treatment,as well as recovery time of laboratory examination results(including PCT,CRP,WBC),duration of extracorporeal circulation and blocking,duration of mechanical ventilation,duration of using antibiotics and ICU stays were compared between the two groups,moreover incidence postoperative complications was recorded. Results (1)Children in the both two groups successfully completed the surgery,while clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)There was no statistically significant difference in OI,PIP,CLdyn,Raw or WOB between the two groups before treatment(P>0.05);OI and CLdyn in observation group were statistically significantly higher than those in control group 15 days after treatment,while PIP,Raw and WOB in observation group were statistically significantly lower than those in

关 键 词：心脏缺损 先天性心脏病 肺炎 儿童 纤维支气管镜 支气管肺泡灌洗术 治疗结果 

分 类 号：R541.1[医药卫生—心血管疾病] R563.1[医药卫生—内科学]