电子支气管镜肺泡灌洗联合俯卧位通气对机械通气重症腺病毒肺炎患儿预后的影响  

Effects of electronic bronchoscopy alveolar lavage combined with prone position ventilation on the prognosis of children with severe adenovirus pneumonia

作　　者：方兴[1] 梅文静[1] 曾日华 曾雪飞[1] 唐尚鸿[1] FANG Xing;MEI Wenjing;ZENG Rihua;ZENG Xuefei;TANG Shanghong(Pediatric Intensive Care Unit,Huizhou Central People's Hospital,Huizhou Guangdong 516000,China)

机构地区：[1]惠州市中心人民医院儿童重症病区,广东惠州516000

出　　处：《中国急救复苏与灾害医学杂志》2022年第12期1614-1617,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：广东省自然科学基金项目(编号:2020A1515010817);惠州市科技计划项目(编号:200410144571767)。

摘　　要：目的探讨电子支气管镜肺泡灌洗联合俯卧位通气对机械通气重症腺病毒肺炎患儿预后的影响。方法选取2019年1月—2021年9月惠州市中心人民医院儿童重症监护病房(PICU)收治的120例机械通气重症腺病毒肺炎患儿,按随机数字表法将患儿分为A、B、C、D四组各30例,A组为对照组给予抗感染、抗炎、雾化、振动排痰、镇静镇痛、营养支持等常规综合治疗,B组在A组基础上给予电子支气管镜肺泡灌洗治疗,C组在A组基础上给予俯卧位通气治疗,D组给予电子支气管镜肺泡灌洗联合俯卧位通气治疗,比较各组临床疗效、临床症状改善情况、心率(HR)、呼吸频率(RR)、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))及血清C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞百分比(NEU)变化。结果D组临床总有效率96.67%高于A组的66.67%、B组的73.33%(P<0.05);D组发热缓解时间、咳嗽症状消失时间、肺湿啰音消失时间、机械通气时间、住院时间均短于A、B、C三组(P<0.05);D组治疗后RR、PaCO_(2)、PaO_(2)/FiO_(2)指标水平改善情况优于A、B、C三组(P<0.05);D组治疗后CRP、WBC、NEU水平均低于A、B、C三组(P<0.05)。结论电子支气管镜肺泡灌洗联合俯卧位通气可有效改善机械通气重症腺病毒肺炎患儿临床症状及呼吸功能情况,并可减轻患儿炎性反应,缩短其住院时间,提升救治成功率,促进预后。Objective To investigate the effects of electronic bronchoscopy alveolar lavage combined with prone position ventilation on the prognosis of children with severe adenovirus pneumonia.Methods 120 children with severe adenovirus pneumonia were hospitalized and randomLy divided into 4 equal groups:Group A(control group)given conventional comprehensive treatments such as anti-infection,anti-inflammatory treatment,nebulization,vibration sputum excretion,sedation and analgesia,and nutritional support,Group B treated with electronic bronchoscopy alveolar lavage in addition,Group C treated with prone position ventilationin addition for 7 days,and Group D treated with electronic bronchoscopy alveolar lavage combined with prone position ventilation in addition for 7 days.Clinical effect,improvement of clinical symptoms,changes in heart rate(HR),respiratory rate(RR),partial pressure of carbon dioxide(PaCO_(2)),and oxygenation index(PaO_(2)/FiO_(2)),serum C-reactive protein(CRP),white blood cell count(WBC),and neutrophil percentage(NEU)were compared among the groups.Results The total clinical response rate of Group D was 96.67%,significantly higher than those of group A(66.67%)and group B(73.33%)(both P<0.05).The fever relief time,cough disappearance time,moist lung rale disappearance time,mechanical ventilation time,and hospital stay of Group D were all significantly shorter than those of the other 3 groups(all P<0.05).After treatment,the improvement degrees of RR,PaCO_(2),and PaO_(2)/FiO_(2)in Group D were all significantly better than those in the other 3 groups(all P<0.05).After treatment,the levels of CRP,WBC,and NEU in Group D were all significantly lower than those in the other 3 groups all(P<0.05).Conclusion Electronic bronchoscopy alveolar lavage combined with prone position ventilation can effectively improve clinical symptoms and respiratory function,relieve inflammatory reactions,shorten hospital stay,improve the success rate of treatment,and the prognosis of children with severe adenovirus pneumonia.

关 键 词：腺病毒肺炎 电子支气管镜肺泡灌洗 俯卧位通气 预后 

分 类 号：R563.1[医药卫生—呼吸系统]