肺泡灌洗术联合地塞米松对大叶性肺炎患儿肺功能及血清炎性因子的影响

doi:10.3760/cma.j.issn.1007-1245.2022.06.016

摘要/Abstract

摘要： 目的　观察肺泡灌洗术联合地塞米松对大叶性肺炎患儿肺功能及血清炎性因子的影响。方法　回顾性选取2017年7月至2021年2月郑州大学附属儿童医院大叶性肺炎患儿50例，根据治疗方案不同分为2组。对照组（24例）女10例，男14例，年龄（6.97±1.02）岁；采用地塞米松治疗。联合组（26例）女11例，男15例，年龄（7.27±1.28）岁；在对照组基础上联合肺泡灌洗术。比较2组治疗效果、症状缓解时间、住院天数、治疗前后肺功能、血清炎性因子水平。计量资料组间行独立样本t检验、组内行配对t检验，计数资料行χ²检验。结果　联合组总有效率92.31%（24/26）与对照组70.83%（17/24）比较差异无统计学意义（P>0.05）。联合组退热时间（4.18±1.67）d、咳嗽减轻时间（7.22±2.50）d、肺部湿啰音消失时间（8.53±1.84）d、大片状影消散时间（8.11±2.34）d及住院天数（9.18±2.37）d短于对照组（7.25±3.84）d、（10.38±4.25）d、（12.20±3.78）d、（11.95±3.62）d、（12.69±4.05）d（均P<0.01）。联合组治疗7 d后第1秒用力呼气容积（FEV₁）（1.38±0.30）L、最高呼气流量（PEF）（4.09±0.96）L/s、用力肺活量（FVC）（1.55±0.28）L高于对照组（1.13±0.25）L、（3.35±0.85）L/s、（1.26±0.32）L（均P<0.01）；联合组治疗7 d后血清可溶性细胞间黏附分子1（sICAM-1）（15.31±3.29）μg/L、白细胞介素6（IL-6）（5.19±1.37）pg/ml、高迁移率族蛋白B1（HMGB1）（60.35±15.62）μg/L低于对照组（24.11±5.82）μg/L、（8.64±3.06）pg/ml、（73.84±20.67）μg/L（均P<0.05）。结论　肺泡灌洗术联合地塞米松有助于减轻大叶性肺炎患儿炎性反应，提高肺功能，缩短症状缓解时间、住院天数。

关键词: 肺泡灌洗术, 地塞米松, 大叶性肺炎, 肺功能, 可溶性细胞间黏附分子1, 高迁移率族蛋白B1

Abstract: Objective　To observe the effects of alveolar lavage combined with dexamethasone on pulmonary function and serum inflammatory factors in children with lobar pneumonia. Methods　A total of 50 children with lobar pneumonia in Children's Hospital Affiliated to Zhengzhou University from July 2017 to February 2021 were selected retrospectively and were divided into two groups according to the treatment plans. In the control group (24 cases), there were 10 females and 14 males, aged (6.97±1.02) years; in the combined group, there were 11 females and 15 males, aged (7.27±1.28) years. The control group was treated with dexamethasone, and the combined group was treated with alveolar lavage on the basis of the control group. The treatment effect, symptom relief time, length of hospital stay, and pulmonary function and serum inflammatory factors levels before and after treatment were compared between the two groups. The measurement data were compared between groups by independent sample t test, paired t test within groups, and the count data by χ² test. Results　There was no statistically significant difference in the total effective rate between the combined group and the control group [92.31% (24/26) vs. 70.83% (17/24)] (P>0.05). The antipyretic time [(4.18±1.67) d], cough relief time [(7.22±2.50) d], lung wet rales disappearance time [(8.53±1.84) d], large patchy shadow dissipation time [(8.11±2.34) d], and length of hospital stay [(9.18±2.37) d] in the combined group were shorter than those in the control group [(7.25±3.84) d, (10.38±4.25) d, (12.20±3.78) d, (11.95±3.62) d, and (12.69±4.05) d] (all P<0.01). After 7 days of treatment, the forced expiratory volume in one second (FEV₁) [(1.38±0.30) L], peak expiratory flow (PEF) [(4.09±0.96) L/s], and forced vital capacity (FVC) [(1.55±0.28) L] in the combined group were higher than those in the control group [(1.13±0.25) L, (3.35±0.85) L/s, and (1.26±0.32) L] (all P<0.01); the serum soluble intercellular adhesion molecule 1 (sICAM-1) [(15.31±3.29) μg/L], interleukin 6 [(5.19±1.37) pg/ml], and high mobility group protein B1 (HMGB1) levels [(60.35±15.62) μg/L] in the combined group were lower than those in the control group [(24.11±5.82) μg/L, (8.64±3.06) pg/ml, and (73.84±20.67) μg/L] (all P<0.05). Conclusion　Alveolar lavage combined with dexamethasone is helpful to reduce inflammatory reaction in children with lobar pneumonia, improve pulmonary function, and shorten symptom relief time and length of hospital stay.

Key words: Alveolar lavage, Dexamethasone, Lobar pneumonia, Pulmonary function, Soluble intercellular adhesion molecule 1, High mobility group protein B1

孙爽爽. 肺泡灌洗术联合地塞米松对大叶性肺炎患儿肺功能及血清炎性因子的影响[J]. 国际医药卫生导报, 2022, 28(6): 800-804.

Sun Shuangshuang.

Effects of alveolar lavage combined with dexamethasone on pulmonary function and serum inflammatory factors in children with lobar pneumonia [J]. International Medicine and Health Guidance News, 2022, 28(6): 800-804.

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