纤维支气管镜早期介入治疗对气道内黏液栓阻塞的儿童肺炎支原体肺炎的价值

Efficacy of early treatment via fiber bronchoscope in children with Mycoplasma pneumoniae pneumonia complicated by airway mucus obstruction

摘要:

目的 探讨纤维支气管镜（简称纤支镜）早期介入治疗在合并有气道内黏液栓阻塞的肺炎支原体肺炎（MPP）患儿中的应用价值。方法 根据入院至行纤支镜介入治疗的时间，将纤支镜下发现气道内黏液栓阻塞的MPP患儿随机分为早期介入组（≤ 3 d；n=40）和晚期介入组（> 3 d；n=56），对两组患儿治疗前后的临床资料进行比较，并随访1~3个月。结果 96例患儿中，38例纤支镜下发现塑型性支气管树形成，其中早期介入组10例，晚期介入组28例（P=0.01）。早期介入组患儿的纤支镜介入治疗后热程、住院时间、WBC恢复正常时间、CRP恢复正常时间短于晚期介入组（P < 0.05）；肺不张复张率高于晚期介入组（P < 0.05）。出院时早期介入组肺部实变吸收面积 ≥ 60%的患儿比例高于晚期介入组；随访3个月时，早期介入组肺部实变吸收面积 ≥ 90%的患儿比例高于晚期介入组（80% vs 55%，P=0.01），而肺不张的发生率低于晚期介入组（P < 0.05）。结论 对于气道内有黏液栓阻塞的MPP患儿，早期行纤支镜介入治疗可缩短病程，减少并发症及后遗症的发生。

Abstract:

Objective To study the efficacy of early treatment via fiber bronchoscope in children with Mycoplasma pneumoniae pneumonia (MPP) complicated by airway mucus obstruction. Methods According to the time from admission to the treatment via fiber bronchoscope, the children with MPP who were found to have airway mucus obstruction under a fiber bronchoscope were randomly divided into early intervention group (≤ 3 days; n=40) and late intervention group (>3 days; n=56). The two groups were compared in terms of clinical data and imaging recovery.The children were followed for 1-3 months. Results Of the 96 children, 38 were found to have the formation of plastic bronchial tree, among whom 10 were in the early intervention group and 28 were in the late intervention group (P=0.01). Compared with the late intervention group, the early intervention group had a shorter duration of fever, length of hospital stay, and time to the recovery of white blood cell count and C-reactive protein (P < 0.05), as well as a higher atelectasis resolution rate (P < 0.05). Compared with the late intervention group, the early intervention group had a higher percentage of children with a ≥ 60% absorbed area of pulmonary consolidation at discharge. After 3 months of follow-up, the early intervention group had a higher percentage of children with a ≥ 90% absorbed area of pulmonary consolidation than the late intervention group (80% vs 55%; P=0.01), and the early intervention group had a lower incidence rate of atelectasis than the late intervention group (P < 0.05). Conclusions Early treatment via fiber bronchoscope can shorten the course of the disease and reduce complications and sequelae in MPP children with airway mucus obstruction.