【摘要】 目的 探讨纤维支气管镜(简称纤支镜)在改善重症肺炎患儿感染指标及血气分析等疗效方面的作用和意义。方法回顾性选取2013年8月-2014年8月在湖南省儿童医院(pediatric intensive care unit,PICU)住院诊断为重症肺炎的299名已行纤支镜的患儿和收集了同期198例重症肺炎但家属拒绝行纤支镜的患儿为研究对象。对纤支镜介入前后感染指标及血气分析改变情况进行分析研究,并与对照组的感染指标进行对比,应用检验和Mann-Whitney U检验对资料进行统计学分析。结果纤支镜介入前后血气分析上吸入氧浓度、PH值、动脉血氧分压、动脉二氧化碳分压、动脉血氧饱和度和乳酸(lactate,LAC)均得到不同程度的改善,差异有统计学意义(P<0.05);感染指标上白细胞、C-反应蛋白、降钙素原较治疗前均出现下降,经配对样本t检验差异有统计学意义(P<0.05),与对照组比较C-反应蛋白、降钙素原明显降低,差异有统计学意义(P<0.05)。结论纤支镜能改善重症肺炎患儿的感染指标及通气情况,有较好的临床应用价值,值得在重症肺炎患儿中推广应用。更多还原

【Abstract】 Objective To investigate the effects of bedside flexible fiberoptic bronchoscopy（FB） on the improvement of infection indexes and blood gas analysis in pediatric severe pneumonia. Methods 299 children with severe pneumonia,216 male and 83 female, 94.97% being aged ltol2 months, were hospitalized in the pediatric intensive care unit（PICU）and underwent bedside FB in addition to conventional treatment（FB Group）, and 198 severe pneumonia children without demography differencewhose parents refused to adopt bedside FB were admitted at the same period and treated only conventionally. Gas analysis was conducted before and 2～4 h after treatment. White blood count, C-reactive protein（CRP）, and procalcitonin（PCT） were measured before and 3～5 d after the treeatment. Results In the FB group,the fraction of inspiration O₂（FiO₂） after treatment was 40%, significantly lower than that before treatment（29%, t=2.67, P=0.009）; the pH after treatment was（7.44±0.06）, significantly higher than that before treatment [（7.41 ±0.08）, t=2.67, P=0.009]; the arterial partial pressureof oxygen（PaO₂） after treatment was（93.37±27.98）,significantly higher than that before treatment [（84.93±30.18）,t=-2.55,P=0.012]; the arterial oxygen saturation（SaO₂） after treatment was（96.90±2.77）,significantly higher than that before treatment [（94.30±6.36）,t=-4.09, P<0.001]; the arterial partial pressure of carbondioxide（PaCO₂） after treatment was（39.33 ±10.53）,significantly lower than that before treatment[（54.62 ± 9.91）, t=2.28, P<0.00]; and the blood lactic acid level（LAC） after treatment was（0.92 ±0.51） mmol/L,significantly lower than that before treatment [（1.35±1.29） mmol/L,t=3.93,P<0.001]. The WBC count after treatment was（9.01±4.92）×10⁹/L, significantly lower than that bebore treatment [（10.59±7.24）×10⁹/L, t=-3.70, P<0.001]; the CRP after treatment was 6.26±16.59, significantly lower than that before treatment [（24.65±37.54）, t=5.26, P<0.001].The PCT after treatment was（1.18±1.76） ng/ml, significantly lower than that before treatment [（5.45±19.99） ng/ml,t=2.50, P=0.014]. The values of WBC, PCT, and CRP o fthe FB group were all significantly lower than those of the control group（all P<0.05）. Conclusions FB helps improve the infection indexes and ventilation in children with severe pneumonia.更多还原