2020 年第 3 期 第 15 卷

电子纤维支气管镜保留灌注乙酰半胱氨酸及布地奈德治疗儿童难治性支原体肺炎的临床效果观察

Clinical efficacy of acetylcysteine and budesonide perfusion through fibrobronchoscope in treatment of refractory Mycoplasma pneumoniae pneumonia in children

作者：曹芳方识进华山刘文君

英文作者：

单位：安徽省儿童医院呼吸科，合肥230022

英文单位：

关键词：难治性支原体肺炎；电子纤维支气管镜；保留灌注；乙酰半胱氨酸；布地奈德

英文关键词：

• 摘要：

• 【摘要】目的    探讨电子纤维支气管镜（纤支镜）保留灌注乙酰半胱氨酸及布地奈德治疗儿童难治性支原体肺炎（RMPP）的临床效果。方法    选取2017年1月至2019年2月安徽省儿童医院收治的45例RMPP患儿作为研究对象，按照随机数字表法分为对照组（22例）和观察组（23例）。对照组患儿在常规治疗基础上给予0.9%氯化钠注射液纤支镜灌洗治疗；观察组患儿在常规治疗基础上采用纤支镜保留灌注乙酰半胱氨酸＋布地奈德治疗。比较2组临床总体疗效、胸部X线疗效、症状缓解时间、住院时间及不良反应情况，测定治疗前后灌洗液白细胞介素17（IL-17）、IL-18、正五聚蛋白3（PTX3）水平。结果    观察组临床总体有效率明显高于对照组［95.7%（22/23）比63.6%（14/22）］，差异有统计学意义（P＝0.007）；胸部X线有效率明显高于对照组［95.7%（22/23）比68.2%（15/22）］，差异有统计学意义（P＝0.016）；咳嗽、肺部啰音、发热缓解时间、住院时间均明显短于对照组［（5.8±1.2）d比（10.9±2.4）d、（4.4±1.2）d比（6.8±1.2）d、（4.1±1.4）d比（6.5±1.5）d、（9.9±1.6）d比（17.6±2.4）d］，差异均有统计学意义（均P＜0.01）。治疗后2组灌洗液IL-17、IL-18、PTX3水平均较治疗前降低，且观察组明显低于对照组［（1.6±0.5）ng/L比（2.2±0.3）ng/L、（14.1±1.1）ng/L比（15.9±1.1）ng/L、（167±46）ng/L比（196±42）ng/L］，差异均有统计学意义（均P＜0.01）。2组不良反应发生率比较［17.4%（4/23）比18.2%（4/22）］，差异无统计学意义（P＝0.945）。结论    纤支镜保留灌注乙酰半胱氨酸及布地奈德可提高儿童RMPP的疗效，促进病灶吸收，加快恢复，且可减轻肺部炎性反应。

  
  

• 【Abstract】Objective    To investigate the clinical effect of acetylcysteine and budesonide perfusion through fibrobronchoscope on refractory Mycoplasma pneumoniae pneumonia（RMPP） in children. Methods    Totally 45 children with RMPP admitted to Anhui Provincial Children′s Hospital from January 2017 to February 2019 were randomly divided into control group(22 cases) and observation group(23 cases). On the basis of routine treatment, the control group was treated with alveolar perfusion of 0.9% sodium chloride and the observation group was treated with acetylcysteine＋budesonide perfusion through fibrobronchoscope. Overall clinical efficacy, chest X-ray efficacy, symptom relief time, hospitalization time and adverse reactions were observed. Contents of interleukin-17(IL-17), IL-18 and pentraxin-3(PTX3) in alveolar lavage fluid were detected. Results    The total effective rate and the effective rate of chest X-ray recovery in observation group were significantly higher than those in control group［95.7%（22/23） vs 63.6%（14/22）, 95.7%（22/23） vs 68.2%（15/22）］（P＝0.007, P＝0.016）. Duration time of cough, pulmonary rales, fever and hospitalization time in observation group were significantly shorter than those in control group［（5.8±1.2）d vs （10.9±2.4）d, （4.4±1.2）d vs （6.8±1.2）d, （4.1±1.4）d vs （6.5±1.5）d, （9.9±1.6）d vs （17.6±2.4）d］（all P＜0.01）. After treatment, levels of IL-17, IL-18 and PTX3 in lavage fluid decreased in both groups; the levels in observation group were significantly lower than those in control group［（1.6±0.5）ng/L vs （2.2±0.3）ng/L, （14.1±1.1）ng/L vs （15.9±1.1）ng/L, （167±46）ng/L vs （196±42）ng/L］（all P＜0.01）. Incidence of adverse reactions showed no significant difference between groups［17.4%（4/23） vs 18.2%（4/22）］（P＝0.945）. Conclusion    Acetylcysteine and budesonide perfusion through fibrobronchoscope can promote lesion recovery, alleviate pulmonary inflammatory response and improve the curative effect on RMPP in children.