目的：观察和评估支气管镜行肺泡灌洗在小儿难治性支原体肺炎中的疗效。方法对确诊为难治性支原体肺炎患儿86例，按是否接受纤维支气管镜术进行肺泡灌洗分为治疗组44例和对照组42例。对照组患儿常规给予大环内酯类抗生素治疗，阿奇霉素10mg/（kg·d）静脉滴注5~7d，合并细菌感染的患儿加用阿莫西林克拉维酸钾100mg/（kg·d），炎症反应重的患儿应用甲强龙2mg/（kg·d）。治疗组患儿在此基础上，采用Olympus 3C40型纤维支气管镜，给予37℃0.9%氯化钠溶液进行支气管肺泡灌洗治疗。结果治疗组平均热程（8.72±2.76）d，对照组为（12.42±1.16）d，差异有统计学意义（t=8.214，P＜0.05）；治疗组平均咳嗽好转时间（10.67±1.84）d，对照组为（14.27±1.89）d，治疗组明显短于对照组，差异有统计学意义（t=8.994，P＜0.05）；治疗组和对照组的影像学恢复时间差异有统计学意义（χ2=7.868，P＜0.05）；治疗组2周内总有效率达93.18%，而对照组仅为61.90%，治疗组的总有效率高于对照组，且差异有统计学意义（P＜0.05，OR=8.410，95%CI：2.230~31.717）。结论应用纤维支气管镜行支气管肺泡灌洗能有效缩短小儿肺炎的发热时间及促进肺部体征的恢复，提高治疗效果。%Objective To evaluate the clinical efficacy of bronchoalveolar lavage in treatment of children with refractory mycoplasma pneumonia. Methods Eighty six children with refractory mycoplasma pneumonia were divided into study group (n=44) and control group (n=42). Both groups received azithromycin 10mg/ (kg·d) i.v for 5~7d, in cases with bacterial infection amoxicil in clavulanic acid potassium 100mg/ (kg·d) was added and methylprednisolone 2mg/ (kg·d) for thoses with severe inflammatory response. On the basis of above treatment, children in study group also underwent bronchoalveolar lavage with 37℃0.9%sodium chloride solution using Olympu 3C40 fiber bronchoscopy. Results The average durations of fever were 8.72±2.76 d in study group, and 12.42±1.16 d in control group (t=8.214, P<0.05). The average cough al eviating time in study group was significantly shorter than that in control group (10.67±1.84 d , 14.27±1.89 d, t=8.994, P<0.05). There was significant difference in radiological image recover time between study group and control group (χ2=7.868, P<0.05). The total effective rate in study group was higher than that in control group (93.18%, 61.90%, P<0.05, OR=8.410, 95%CI=2.230~31.717). Conclusion Bronchoalveolar lavage can enhance therapeutic effect, reduce cough al eviating time and promote lung functions in children with refractory mycoplasma pneumonia.
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