Effect of bronchoalveolar lavage with ambroxol combined with Shenqi Fuzheng Injection in treatment of children with severe bronchopneumonia
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摘要:目的 观察支气管镜肺泡灌洗氨溴索结合参芪扶正注射液治疗小儿重症支气管肺炎的临床效果。方法 分析205例重症支气管肺炎患儿的临床资料，根据病原体的不同将患儿分为病毒组、细菌组、混合组、其他组，比较4组患儿的炎症因子水平、治疗情况和临床疗效，并分析支气管肺泡灌洗液中白细胞介素-23（IL-23）水平与肿瘤坏死因子-α（TNF-α）水平的相关性。结果 细菌组、混合组的住儿科重症监护（PICU）时间、住院时间和使用抗生素时间均长于病毒组、其他组，IL-23、TNF-α表达水平高于病毒组、其他组，差异有统计学意义（P < 0.05）。患儿支气管肺泡灌洗液中IL-23水平与TNF-α水平呈显著正相关（r=0.978，P < 0.001）。治疗7 d后，支气管肺炎患儿动脉血二氧化碳分压水平低于治疗前，氧合指数高于治疗前，发热、咳嗽者占比低于治疗前，差异均有统计学意义（P < 0.05）。病毒组、细菌组的治疗有效率高于混合组、其他组，差异有统计学意义（P < 0.05）。结论 支气管镜肺泡灌洗氨溴索结合参芪扶正注射液能够有效改善重症支气管肺炎患儿的临床症状，且有助于明确支气管肺炎的病原体。Abstract:Objective To observe the clinical effect of bronchoalveolar lavage with ambroxol combined with Shenqi Fuzheng Injection in treatment of severe bronchopneumonitis in children.Methods Clinical data of 205 children with severe bronchopneumonia was analyzed. The children were divided into viral group, bacterial group, mixed group and other pathogen group according to different pathogens. The levels of inflammatory factors, treatment and clinical efficacy of the four groups were compared. The correlation between the levels of interleukin-23 (IL-23) and tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid was analyzed.Results The duration of pediatric intensive care unit (PICU), hospital stay and antibiotic use in the bacterial group and the mixed group were longer than those in the viral group and the other pathogen groups, and the expression levels of IL-23 and TNF-α were higher than those in the viral group and the other pathogen group (P < 0.05). There was a significant positive correlation between IL-23 and TNF-α levels in bronchoalveolar lavage fluid (r=0.978, P < 0.001). After 7 days of treatment, arterial partial pressure of carbon dioxide was lower than before treatment, oxygenation index was higher than before treatment, and the proportions of fever and cough were lower than before treatment (P < 0.05). The effective rates of the viral group and the bacterial group were higher than those in the mixed group and the other pathogen group (P < 0.05).Conclusion Bronchoscopic alveolar lavage with ambroxol and Shenqi Fuzheng Injection can effectively improve the clinical symptoms of children with severe bronchopneumonia, and help to identify the pathogen of bronchopneumonia.
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Keywords:
- bronchoalveolar lavage /
- ambroxol /
- Shenqi Fuzheng Injection /
- children /
- severe bronchopneumonia
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表 1 4组支气管肺炎患儿的基本资料比较[n(%)]
指标 n 病毒组(n=59) 细菌组(n=49) 混合组(n=36) 其他组(n=61) 性别 男 142 37(62.71) 35(71.43) 25(69.44) 45(73.77) 女 63 22(37.29) 14(28.57) 11(30.56) 16(26.23) 年龄 1~ < 3岁 31 6(10.17) 10(20.41) 3(8.33) 12(19.67) 3~ < 10岁 157 48(81.36) 34(69.39) 32(88.89) 43(70.49) 10~14岁 17 5(8.47) 5(10.20) 1(2.78) 6(9.84) 
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表 2 4组支气管肺炎患儿的治疗情况比较(x±s)
指标 病毒组(n=59) 细菌组(n=49) 混合组(n=36) 其他组(n=61) 住PICU时间/d 11.31±2.97 18.29±3.64*# 14.87±3.18*# 11.72±3.42 使用抗生素时间/d 13.14±3.76 20.02±3.75*# 17.31±4.02*# 14.87±3.89 住院时间/d 15.17±3.95 21.31±3.62*# 19.75±3.83*# 16.73±3.24 PCIS评分/分 91.39±13.67 90.09±12.08 89.79±14.55 90.54±14.78 PICU: 儿科重症监护病房; PCIS: 小儿危重病例评分法。与病毒组比较, *P < 0.05; 与其他组比较, #P < 0.05。
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表 3 4组支气管肺炎患儿的炎症因子表达水平比较(x±s)
组别 WBC/(×109/L) PCT/(ng/L) CRP/(mg/L) IL-23/(pg/mL) TNF-α/(ng/mL) 病毒组(n=59) 8.12±0.66 0.39±0.24 8.61±5.72 516.96±72.88 3.82±0.67 细菌组(n=49) 10.01±0.13 0.42±0.70 8.71±0.93 531.74±67.60*# 4.04±0.55*# 混合组(n=36) 9.78±0.06 0.21±0.92 8.55±1.44 559.60±80.31*# 4.08±0.58*# 其他组(n=61) 8.89±0.26 0.32±0.82 6.84±0.26 488.71±78.86 3.71±0.64 WBC: 白细胞; PCT: 降钙素原; CRP: C反应蛋白; IL-23: 白细胞介素-23; TNF-α: 肿瘤坏死因子-α。
与病毒组比较, *P < 0.05; 与其他组比较, #P < 0.05。
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表 4 205例支气管肺炎患儿不同时点临床治疗指标比较(x±s)[n(%)]
指标 治疗前 治疗1 d后 治疗3 d后 治疗7 d后 pa(CO2)/mmHg 45.13±9.32 40.69±8.82 39.38±7.05 38.44±8.56* 氧合指数/mmHg 287.89±84.21 292.69±86.78 307.65±89.78 314.31±90.43* 发热 94(45.85) 78(38.05) 70(34.15) 66(32.20)* 咳嗽 184(89.76) 174(84.88) 162(79.02) 153(74.63)* pa(CO2): 动脉血二氧化碳分压。与治疗前比较, *P < 0.05。
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表 5 4组患儿治疗效果比较[n(%)]
组别 有效 无效 病毒组(n=59) 43(72.88)*# 16(27.12)*# 细菌组(n=49) 35(71.43)*# 14(28.57)*# 混合组(n=36) 20(55.56)* 16(44.44)* 其他组(n=61) 28(45.90) 33(54.10) 与其他组比较, *P < 0.05; 与混合组比较, #P < 0.05。
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