不同时机支气管肺泡灌洗治疗儿童难治性肺炎支原体肺炎的效果及疗效不佳危险因素分析OA
Analysis of the efficacy and risk factors for poor therapeutic effect of bronchoalveolar lavage at different timings in the treatment of refractory Mycoplasma pneumoniae pneumonia in children
目的 探讨不同时机支气管肺泡灌洗(BAL)治疗儿童难治性肺炎支原体肺炎(RMPP)的效果及疗效不佳危险因素.方法 选取2023年4月至2024年10月收治的200例RMPP患儿,根据首次BAL治疗时机分为早期介入组(病程8～14 d)94例、中期介入组(病程15～21 d)71例和晚期介入组(病程>21 d)35例.比较不同时机BAL治疗对RMPP患儿的临床疗效、发热持续时间、咳嗽持续时间、影像学表现吸收时间、住院时间及不良事件发生率的影响.多因素Logistic回归分析影响RMPP患儿BAL治疗效果不佳的危险因素.结果 早期介入组总有效率为89.36%(84/94),高于中期介入组的77.46%(55/71)和晚期介入组的71.43%(25/35,P<0.05).早期介入组发热持续时间、咳嗽持续时间、影像学表现吸收时间及住院时间均短于中期介入组和晚期介入组(P<0.05).疗效不佳组气促占比、热程、大环内酯类药物使用时间、肺不张占比、支原体耐药基因位点阳性占比、镜下支气管管腔炎性狭窄占比、白细胞计数、C反应蛋白、BAL治疗时病程均高于或长于有效组(P<0.05).热程长、支原体耐药基因位点阳性占比高和BAL治疗时病程长均为影响RMPP患儿BAL治疗效果不佳的独立危险因素(P<0.05).3组术后不良事件总发生率比较无统计学差异(P>0.05).结论 早期应用支气管镜进行BAL治疗可有效提高RMPP患儿临床效果,BAL治疗效果不佳与热程、支原体耐药基因位点阳性和BAL治疗时病程等因素有关.
Objective To investigate the efficacy and risk factors for poor therapeutic effect of bronchoalveolar lavage(BAL)at different timings for the treatment of refractory Mycoplasma pneumoniae pneumonia(RMPP)in children.Methods A total of 200 children with RMPP who were admitted from April 2023 to October 2024 were selected.They were divided into the early intervention group(with a disease course of 8 to 14 d),the mid-term intervention group(with a disease course of 15 to 21 d),and the late intervention group(with a disease course of more than 21 d)based on the timing of the first treatment with BAL.The clinical efficacy,duration of fever,duration of cough,time to radiographic resolution,length of hospital stay,and incidence of adverse events after BAL therapy in RMPP children at different timings were compared.Multivariate logistic regression analysis was used to identify the risk factors affecting the poor therapeutic effect of BAL treatment in RMPP children.Results The total effective rate of the early intervention group was 89.36%(84/94),which was higher than that of the mid-term intervention group(77.46%,55/71)and the late intervention group(71.43%,25/35)(P<0.05).The duration of fever,cough,time to radiographic resolution and length of hospital stay in the early intervention group were shorter than those in the mid-term intervention group and the late intervention group(P<0.05).The proportion of shortness of breath,duration of fever,duration of use of Macrolide drugs,proportion of atelectasis,proportion of positive mycoplasma resistance gene loci,proportion of inflammatory stenosis of bronchial lumen under microscopic observation,white blood cell count,C-reactive protein,and duration of disease during BAL treatment were all higher or longer in poor therapeutic effect group than in the good therapeutic effect group(P<0.05).Long duration of fever,high proportion of positive mycoplasma resistance gene loci and long duration of BAL treatment were all independent risk factors affecting the poor therapeutic effect of BAL therapy in children with RMPP(P<0.05).No significant difference was observed in the overall incidence of postoperative adverse events among the three groups(P>0.05).Conclusion Early application of bronchoscopy for BAL therapy can effectively improve the clinical outcomes of children with RMPP.The poor therapeutic effect with BAL is related to the duration of the disease,the presence of positive mycoplasma resistance gene loci,and the disease duration during BAL administration.
杨芳;张贺;冀虎;安红娇;崔倩倩
首都医科大学附属北京儿童医院保定医院呼吸科,河北 保定 071000首都医科大学附属北京儿童医院保定医院呼吸科,河北 保定 071000首都医科大学附属北京儿童医院保定医院医务科,河北 保定 071000首都医科大学附属北京儿童医院保定医院门诊部,河北 保定 071000保定市妇幼保健院检验科,河北 保定 071000
难治性肺炎支原体肺炎儿童支气管肺泡灌洗治疗时机不良事件危险因素
refractory mycoplasma pneumoniae pneumoniachildrenbronchoalveolar lavagetreatment timingadverse eventrisk factor
《临床误诊误治》 2026 (3)
34-40,7
保定市科技计划项目(2341ZF173)
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