早期电子支气管镜肺泡灌洗在野外淹溺患儿中的应用:单中心经验  

Early application of bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases:Single-center experience

作　　者：周雄[1] 贺杰[1] 刘颖 黄康 彭雅妮 朱德胜[1] 肖政辉[1] 张新萍[1] Zhou Xiong;He Jie;Liu Ying;Huang Kang;Peng Yani;Zhu Desheng;Xiao Zhenghui;Zhang Xinping(Department of Pediatrics Intensive Care Unit,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院重症医学科,长沙410007

出　　处：《中国小儿急救医学》2025年第1期50-55,共6页Chinese Pediatric Emergency Medicine

基　　金：湖南省临床医疗技术创新引导项目(2021SK50518);湖南省卫计委一般项目(B20180575)。

摘　　要：目的探讨早期电子支气管镜肺泡灌洗术在野外淹溺患儿中的应用价值。方法回顾性分析2017年1月至2023年9月在湖南省儿童医院重症医学科救治的81例野外淹溺患儿的临床资料。将于淹溺后24 h内入科并接受电子支气管镜肺泡灌洗的43例患儿作为支气管镜灌洗组(治疗组),另38例在24 h未入科或24 h后才进行电子支气管镜肺泡灌洗的患儿作为对照组。比较两组在入院前、入院时的观察指标及病情进展或预后观察指标,评价早期电子支气管镜肺泡灌洗对野外淹溺患儿的临床治疗效果。结果与对照组相比,治疗组患儿有创通气时间显著缩短[(73.33±13.33)h比(94.82±15.77)h],PICU住院时间也显著减少[105.00(94.00,121.00)h比123.5(109.75,149.00)h],差异均有统计学意义(均P<0.05)。在入院时及第1天,治疗组与对照组白细胞计数和中性粒细胞百分比无显著差异(均P>0.05)。入院第3天,两组患儿的白细胞计数明显改善,差异有统计学意义(P<0.05)。治疗组与对照组在第1天和第3天的C-反应蛋白和降钙素原均显著下降,差异均有统计学意义(均P<0.05)。使用电子支气管镜肺泡灌洗治疗后6 h,治疗组的P/F比值较对照组有所下降[(177.09±41.27)比(233.50±48.23)],但在第24小时,上升更为显著[(286.00±34.32)比(256.34±44.22)],差异均有统计学意义(均P<0.05)。治疗组灌洗液培养阳性率明显高于对照组,差异有统计学意义(P<0.05)。在器官功能损伤数量方面,两组之间差异无统计学意义(P>0.05),但在存活率方面,治疗组明显优于对照组,差异有统计学意义(P<0.05)。结论对于野外淹溺患儿,早期电子支气管镜肺泡灌洗术可能缩短有创机械通气时间和PICU住院时间,改善预后,值得推广。Objective To evaluate the efficacy of early bronchoalveolar lavage using electronic bronchoscopy in pediatric drowning cases.MethodsA retrospective analysis of clinical data from 81 pediatric drowning cases treated in the intensive care unit of Hunan Children's Hospital from January 2017 to September 2023 was conducted.Among these,43 cases underwent bronchoalveolar lavage with electronic bronchoscopy within 24 hours of drowning,constituting the treatment group,while 38 cases either did not receive treatment within 24 hours or underwent the procedure after 24 hours,forming the control group.We compared the two groups regarding pre-admission observations,admission observations,and disease progression or prognosis indicators to assess the clinical efficacy of early bronchoalveolar lavage with electronic bronchoscopy in pediatric drowning cases.ResultsCompared to the control group,children in the treatment group exhibited a significant reduction in invasive ventilation time[(73.33±13.33)h vs.(94.82±15.77)h]and a significant decrease in pediatric intensive care unit stay[105.00(94.00,121.00)h vs.123.5(109.75,149.00)h],with both differences being statistically significant(P<0.05).No significant differences in white blood cell count and neutrophil percentage were observed between the treatment group and control group at admission and on the first day(P>0.05).However,by the third day,there was a significant improvement in white blood cell count in both groups,with statistical significance(P<0.05).There was a significant decrease in C-reactive protein and procalcitonin levels between the treatment group and control group on the 1st and 3rd days,with the differences being significant(P<0.05).Six hours after electronic bronchoalveolar lavage,the P/F ratio in the treatment group was lower than that in the control group(177.09±41.27 vs.233.50±48.23),but it increased more significantly at 24 hours(286.00±34.32 vs.256.34±44.22),with a significant difference between two groups.The positive rate of lavage fluid culture in t

关 键 词：野外 淹溺 电子支气管镜肺泡灌洗 危重症 小儿危重病例评分 儿童 

分 类 号：R720.597[医药卫生—急诊医学]