快速现场评价技术在指导儿童重症肺炎支气管肺泡灌洗后续诊疗价值的初步评价  

Preliminary assessment of rapid on-site evaluation in guiding the follow-up diagnosis and treatment of bronchoalveolar lavage in children with severe pneumonia

作　　者：刘翔腾[1] 王桂兰[1,2] 黄娟 林嘉镖[1] 容嘉妍[1] 王冰洁[1] LIU Xiang-teng;WANG Gui-lan;HUANG Juan;LIN Jia-biao;RONG Jia-yan;WANG Bing-jie(Department of Children Respiratory,Zhongshan Boai Hospital,Zhongshan,Guangdong 528403,China;Department of Pediatrics,The second Clinical Medical College of Southern Medical University,Guanzhou,Guangdong 510280,China)

机构地区：[1]中山市博爱医院小儿呼吸科,广东中山528403 [2]南方医科大学第二临床医学院儿科,广东广州510280

出　　处：《临床肺科杂志》2021年第11期1672-1676,共5页Journal of Clinical Pulmonary Medicine

基　　金：广东省卫健委医学科研基金资助课题(No.A2020566);广东省中山市科技计划项目(No.2020B1046)。

摘　　要：目的探讨快速现场评价(ROSE)技术在指导儿童重症肺炎支气管肺泡灌洗的后续诊疗价值。方法选取2018年1月至2021年2月本院收治的儿童重症肺炎240例为研究对象,以家属是否同意行支气管镜肺泡灌洗及ROSE分为单纯灌洗组100例,灌洗+ROSE组100例,剩余40例均不同意行灌洗及ROSE技术的患儿作为对照组。对3组患儿治疗前后的血气、炎症指标及应用价值指标进行分析。结果治疗后3组患儿PaO_(2)、PaO_(2)/FiO_(2)均高于治疗前(P<0.05),而PaCO_(2)、CRP、PCT、IL-6均低于治疗前(P<0.05);治疗后对照组PaO_(2)、PaO_(2)/FiO_(2)均低于单纯灌洗组及灌洗+ROSE组(P<0.05),而PaCO_(2)、CRP、PCT、IL-6均高于单纯灌洗组及灌洗+ROSE组(P<0.05);单纯灌洗组及灌洗+ROSE组PICU住院时间、机械通气时间、住院天数、医疗总费用、死亡率均低于对照组(P<0.01),而总有效率均高于对照组(P<0.01);灌洗+ROSE组抗生素使用天数、使用种类、真菌定植率均低于对照组及单纯灌洗组(P<0.05)。结论ROSE指导重症肺炎患儿在行支气管肺泡灌洗后续诊疗,能减少抗生素的使用天数及种类,减少真菌定植率,可为抗生素的合理应用提供参考。Objective To investigate the value of rapid onsite evaluation(ROSE)in the follow-up diagnosis and treatment of bronchoalveolar lavage in children with severe pneumonia.Methods 240 cases of children with severe pneumonia from January 2018 to February 2021 were selected as the research objects.They were divided into simple lavage group(n=100)and lavage+ROSE group(n=100)according to whether their families agreed to bronchoalveolar lavage and ROSE,the remaining 40 children who did not agree to lavage and rose technique were taken as the control group.Blood gas analysis,inflammation index and application value index of the three groupswere analyzed before and after treatment.Results After treatment,the levels of PaO_(2) and PaO_(2)/FiO_(2) in the threegroups were higher than those before treatment(P<0.05),while PaO_(2),CRP,PCT and IL-6 were lower than thosebefore treatment(P<0.05);After treatment,PaO_(2) and PaO_(2)/FiO_(2) of the control group were lower than those in thesimple lavage group and lavage+ROSE Group(P<0.05),while PaCO_(2),CRP,PCT and IL-6 in non-lavage groupwere higher than those in simple lavage group and lavage+ROSE Group(P<0.05);The length of stay,duration ofmechanical ventilation,length of stay,total medical expenses and mortality of PICU in the simple lavage group andlavage+ROSE group were lower than those in the control group(P<0.01),while the total effective rate was higherthan that in the control group(P<0.01);The application times,types,and colonization rate of antibiotics in thelavage+ROSE group were lower than those in the control group and the simple lavage group(P<0.05).Conclusion ROSE can guide the follow-up diagnosis and treatment of bronchoalveolar lavage in children with severe pneu-monia,thereby reducing the days and types of antibiotic use and the rate of fungal colonization,and providing refer-ence for the rational use of antibiotics.

关 键 词：支气管肺泡灌洗 快速现场评价 炎症指标 应用价值 重症肺炎 儿童 

分 类 号：R725.6[医药卫生—儿科]