文章摘要

纤维支气管镜肺泡灌洗术联合振动排痰法在重症肺炎机械通气患儿的临床应用

作者: 1兰婷婷, 1詹璐, 1邓全敏, 1黄琴, 1伍俐
1 德阳市人民医院儿科,四川 德阳 618000
通讯: 兰婷婷 Email: 470239968@qq.com
DOI: 10.3978/j.issn.2095-6959.2021.03.015

摘要

目的:研究纤维支气管镜(以下简称纤支镜)肺泡灌洗术(bronchoalveolar lavage,BAL)联合振动排痰法救治重症肺炎机械通气患儿的临床效果。方法:选取2018年2月至2020年1月在德阳市人民医院儿童重症医学科(pediatric intensive care unit,PICU)接受救治的120例重症肺炎机械通气患儿,采用简单随机分组法将患儿分为BAL组和联合组,每组均60例。所有患儿均接受抗感染、化痰、止咳等对症治疗,BAL组给予BAL治疗,灌洗期间密切生命体征监测;联合组给予BAL联合高频振动排痰治疗,高频振动排痰在BAL治疗前20 min进行。观察两组患儿BAL治疗前后呼吸功能和炎症因子等指标变化,比较两组患儿排痰量、机械通气时间、PICU住院时间、28 d病死率和评估临床疗效。结果:两组治疗2 h后氧合指数(oxygenation index,PaO2/FiO2)、动态顺应性(dynamic compliance,Cydn)均较治疗前明显升高,动脉二氧化碳分压(partial pressure of carbon dioxide,PaCO2)显著下降(P<0.05),联合组治疗2 h后上述指标均较BAL组明显改善(P<0.05);两组治疗5 d后血清降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、白细胞计数(white blood cell,WBC)均较治疗前明显下降(P<0.05),联合组治疗5 d后血清PCT、CRP显著低于BAL组(P<0.05);联合组BAL排痰量多于BAL组,机械通气时间、PICU住院时间短于BAL组,差异均有统计学意义(P<0.05),组间28 d病死率比较无明显差异(P>0.05)。联合组治疗总有效率96.67%,明显高于BAL组的85.00%(P<0.05)。结论:BAL联合振动排痰法可帮助重症肺炎机械通气患儿充分排痰和改善呼吸功能,减轻炎症反应,缩短机械通气时间和PICU住院时间,增益临床疗效。
关键词: 重症肺炎;机械通气;患儿;纤维支气管镜肺泡灌洗术;振动排痰法;气道管理;呼吸功能;近期预后

Clinical application of bronchoalveolar lavage combined with vibration expectoration in children with severe pneumonia undergoing mechanical ventilation

Authors: 1LAN Tingting, 1ZHAN Lu, 1DENG Quanmin, 1HUANG Qin, 1WU Li
1 Department of Pediatrics, Deyang People’s Hospital, Deyang Sichuan 618000, China

CorrespondingAuthor: LAN Tingting Email: 470239968@qq.com

Abstract

Objective: To study the clinical effect of bronchoalveolar lavage (BAL) combined with vibration expectoration in the treatment of children with severe pneumonia undergoing mechanical ventilation. Methods: From February 2018 to January 2020, 120 children with severe pneumonia receiving mechanical ventilation in the pediatric intensive care unit (PICU) of Deyang People’s Hospital were selected. The children were randomly divided into a BAL group and a combined group, with 60 cases in each group. All the children received symptomatic treatment such as anti-infection, expectoration, and cough relieving. The children in the BAL group were given BAL treatment, and vital signs were closely monitored during lavage; the children in the combined group were given bronchoalveolar lavage combined with high-frequency vibration expectoration treatment, which was performed 20 minutes before BAL treatment. The changes of respiratory function and inflammatory factors before and after BAL treatment were observed. The sputum output, mechanical ventilation time, PICU hospital stay, 28-day mortality, and clinical efficacy were compared between the 2 groups. Results: After 2 hours of treatment for both groups, oxygenation index (PaO2/FiO2) and dynamic compliance (Cydn) were significantly increased, partial pressure of carbon dioxide (PaCO2) was significantly decreased (P<0.05); the above indexes in the combined group were significantly improved than those in the BAL group (P<0.05). After 5 days of treatment, serum procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) in the 2 groups were significantly lower than those before the treatment (P<0.05); the levels of serum PCT and CRP in the combined group were significantly lower than those in the BAL group (P<0.05). The sputum excretion volume of BAL in the combined group was more than that in the BAL group and the mechanical ventilation time and PICU hospitalization time were shorter than those in the BAL group (P<0.05). However, there was no significant difference in 28-day mortality between the 2 groups (P>0.05). After the treatment, the total effective rate of the combined group was 96.67%, which was significantly higher than that of the BAL group (85.00%, P<0.05). Conclusion: BAL combined with vibration expectoration can help children with severe pneumonia fully expectorate, improve respiratory function, reduce inflammatory reaction, shorten mechanical ventilation time and PICU hospitalization time, and increase clinical efficacy.
Keywords: severe pneumonia; mechanical ventilation; children; bronchoalveolar lavage; vibration expectoration; airway management; respiratory function; short-term prognosis