| 摘要: |
| 目的:探讨支气管肺泡灌洗(BAL)联合甲泼尼龙琥珀酸钠辅助治疗难治性肺炎支原体肺炎(RMPP)的临床疗效及对肺
功能的影响。方法:选取2021 年1 月至2022 年6 月在我院儿童呼吸科住院并诊断为RMPP 的患儿96 例。根据是否行 BAL 分
为激素治疗组(n =42)和联合治疗组(n =54),激素治疗组采用常规大环内酯类药物抗感染基础上加用小剂量甲泼尼龙琥珀酸
钠治疗;联合治疗组在激素治疗组的基础上加用BAL。比较两组患儿咳嗽改善时间、体温恢复正常时间、肺部体征明显吸收好
转时间、住院时间及肺部影像学吸收情况,并对入院时肺功能和出院1 个月后肺功能进行分析。结果:治疗后,联合治疗组的总
有效率为96. 30%,激素治疗组为80. 95%,差异有统计学意义(P<0. 05)。联合治疗组的咳嗽改善时间、体温恢复正常时间、肺
部体征明显吸收时间、住院时间、胸部影像学吸收效果优于激素治疗组( P <0. 05)。96 例RMPP 患儿中肺功能异常91 例
(94. 79%),其中49 例为混合性通气功能障碍(49/ 96,51. 04%),25 例为阻塞性通气功能障碍(25/ 96,26. 04%),11 例为小气道
功能障碍(11/ 96,11. 46%),6 例为限制性通气功能障碍(6/ 96,6. 25%)。入院时两组患儿肺功能指标呼气峰流量( PEF)、第1
秒用力呼气容积(FEV1)、用力呼气流量(FEF)25%、FEF50%、FEF75%、最大呼气中期流量(MMEF)、用力肺活量(FVC) 水平比
较,差异无统计学意义(P>0. 05)。但出院后1 个月两组患儿肺功能指标比较,差异有统计学意义(P<0. 05),联合治疗组的肺
功能改善更明显。结论:BAL 联合甲泼尼龙琥珀酸钠治疗RMPP 相比单用甲泼尼龙琥珀酸钠治疗,具有更好的临床疗效和更
快的病灶吸收速度;超过90%的RMPP 患儿存在肺功能异常,其中以混合性通气功能异常最常见,其次是阻塞性通气功能异
常。通过BAL 可加速肺功能的改善,促进肺功能恢复。 |
| 关键词: 难治性肺炎支原体肺炎 支气管肺泡灌洗 甲泼尼龙琥珀酸钠 肺功能 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2024.05.011 |
|
| 基金项目: |
|
| Clinical Efficacy of Bronchoalveolar Lavage Combined with Methylprednisolone in Adjuvant Treatment ofRefractory Mycoplasma Pneumoniae Pneumonia and Its Effects on Pulmonary Function |
| Qiao Yingqin, Mo Yunbo, Yu Jie, Peng Zhe, Zhou Gang |
| (Three Gorges Hospital Affiliated to Chongqing University,
Chongqing 404000, China) |
| Abstract: |
| Objective: To explore the clinical efficacy of bronchoalveolar lavage (BAL) combined with methylprednisolon in the
treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP) and its effects on pulmonary function, and to summarize its clinical
significance. Methods: A total of 96 children diagnosed with RMPP and admitted into the department of pediatric respirology in our
hospital from Jan. 2021 to Jun. 2022 were extracted to be divided into the hormone treatment group (n =42) and combination treatment
group (n =54) based on parental preference of BAL. The hormone treatment group was treated with conventional macrolides for antiinfection
with small doses of methylprednisolone sodium succinate, while the combination treatment group received BAL on the basis of
hormone treatment group. Cough improvement time, time to normal body temperature, time for significant absorption of pulmonary signs,
length of stay and radiographic improvement of two groups were observed and compared. The pulmonary function at admission and 1 month
after discharge were also analyzed. Results: After treatment, the total effective rate of the combination treatment group was 96. 30%,
while the hormone treatment group was 80. 95%, with statistically significant difference (P<0. 05). The cough improvement time, time
to normal body temperature, time for significant absorption of pulmonary signs, length of stay and radiographic improvement in the
combination treatment group were shorter than those in hormone treatment group, the differences were statistically significant (P<0. 05).
Among the 96 children with RMPP, 91 cases (94. 79%) had abnormal pulmonary function. Among the cases with abnormal pulmonary
function, 49 cases (49/ 96, 51. 04%) had mixed ventilatory dysfunction, 25 cases (25/ 96, 26. 04%) had obstructive ventilatory
dysfunction, 11 cases (11/ 96, 11. 46%) had small airway dysfunction, and 6 cases (6/ 96, 6. 25%) had restrictive ventilatory
dysfunction. No statistically significant differences were found in peak expiratory flow (PEF), forced expiratory volume in one second
(FEV1), forced expiratory flow at 25% (FEF25%), FEF50%, and FEF75%, maximum mid-expiratory flow (MMEF), and forced
vital capacity (FVC) between two groups at admission (P > 0. 05). However, one month after discharge, there was statistically
significant difference in pulmonary function indicators between two groups (P<0. 05), and the pulmonary function improvement of the
combination treatment group was more significant than hormone treatment group. Conclusion: BAL combined with methylprednisolone
sodium succinate in the treatment of RMPP has better clinical efficacy and faster lesion absorption rate compared with methylprednisolone
sodium succinate alone. Over 90% of children with RMPP have abnormal pulmonary function, with mixed ventilatory dysfunction being
the most common, followed by obstructive ventilatory dysfunction. BAL can accelerate the improvement of pulmonary function and
promote the recovery of pulmonary function. |
| Key words: refractory Mycoplasma pneumoniae pneumonia bronchoalveolar lavage methylprednisolone sodium succinate pulmonary
function |
