支气管肺泡灌洗术治疗时机对重症支原体肺炎伴肺不张患儿影像学恢复的影响

Effect of treatment timing of bronchoalveolar lavage on imaging recovery in children with severe Mycoplasma pneumoniae pneumonia and atelectasis

摘要:

目的：探索儿童重症肺炎支原体肺炎伴肺不张治疗中支气管肺泡灌洗术（bronchoalveolar lavage，BAL）的不同治疗时机与胸片恢复的关系。方法：选取2017年1月至2018年2月期间于重庆医科大学附属儿童医院确诊的重症肺炎支原体肺炎伴肺不张的患儿作为研究对象，根据行支气管肺泡灌洗术时病程分为A组（≤10 d，55例）、B组（10~20 d，94例）、C组（≥21 d，66例）。分别于术后1周及术后1个月左右复查胸片，比较3组患儿肺不张吸收情况。结果：3组患儿术后1周随访胸片恢复情况比较：Kruskal-Wallis H检验：χ2=39.542，P=0.000。说明3组患儿术后1周随访胸片恢复情况存在统计学意义。进一步进行组间两两比较，A组与B组比较（PAB=0.026）；A组与C组比较（PAC=0.000）；B组与C组比较（PBC=0.000）；说明3组患儿术后1周随访胸片吸收情况，A组优于C组，B组优于C组，A组及B组无明显差别。3组患儿术后1月随访胸片恢复情况比较：Kruskal-Wallis H检验：χ2=58.717，P=0.000。说明3组患儿术后1月胸片恢复情况存在统计学意义。进一步进行组间两两比较显示：A组与B组比较（PAB=0.01）；A组与C组比较（PAC=0.000）；B组与C组比较（PBC=0.000）；组间两两比较均具有统计学意义，说明3组患儿术后1月随访胸片恢复情况均存在差异，吸收情况A组优于B、C组，B组优于C组。结论：对于重症肺炎支原体肺炎伴肺不张的患儿，BAL早期介入（10 d以内）有助于减轻病情、促进影像学恢复，从而改善预后。

Abstract:

Objective：To investigate the association of treatment timing of bronchoalveolar lavage（BAL） with chest X-ray recovery in children with severe Mycoplasma pneumoniae pneumonia and atelectasis. Methods：A total of 215 children who were diagnosed with severe mycoplasma pneumonia and atelectasis in Children’s Hospital Affiliated to Chongqing Medical University from January 2017 to February 2018 were enrolled as subjects，and according to the course of disease at the time of BAL treatment，they were divided into group A（≤10 days，55 children），group B（10-20 days，94 children），and group C（≥ 21 days，66 children）. Chest X-ray was performed at one week and one month after surgery，and the recovery from atelectasis was compared between groups. Results：There was a significant difference in the recovery of chest radiograph between the three groups at one week after surgery，based on the Kruskal-Wallis H test（χ2=39.542，P=0.000）. Further comparison between two groups showed that group A had a significantly better recovery of chest radiograph than group C（P=0.000），and group B had a significantly better recovery of chest radiograph than group C（P=0.000），while there was no significant difference between group A and group B（P=0.026）. At one month after surgery，there was a significant difference in the recovery of chest radiograph between the three groups，based on the Kruskal-Wallis H test（χ2=58.717，P=0.000）. Further compari－son between two groups showed that group A had a significantly better recovery of chest radiograph than groups B and C（P=0.01 and 0.000），and group B had a significantly better recovery than group C（P=0.000）. Conclusion：In children with severe Mycoplasma pneumoniae pneumonia and atelectasis，early BAL intervention （within 10 days） can help to alleviate their conditions，promote imag－ing recovery，and improve prognosis.