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目的探讨经支气管镜在气管内局部注射布地奈德混悬液,对治疗儿童肺炎支原体大叶性肺炎疗效的影响。方法 52例儿童肺炎支原体大叶性肺炎患儿,按就诊的先后顺序分为雾化组和灌洗组,各26例。两组患儿均给予基础治疗,阿奇霉素静脉滴注,序贯口服治疗,合并细菌感染时给予头孢曲松抗感染,支气管肺泡灌洗,合并胸腔积液者行胸腔穿刺引流。雾化组给予布地奈德混悬液经空气压缩泵雾化吸入;灌洗组给予布地奈德混悬液经支气管镜注射于局部支气管内治疗。比较两组的临床疗效,观察患儿住院治疗后的退热时间,治疗10 d胸部X线好转情况及住院时间,并观察不良反应。结果灌洗组住院治疗后的退热时间、治疗10 d后胸部X线好转例数及住院时间分别为(4.7±0.8)d、23例、(11.4±1.4)d,与雾化组的(5.6±1.2)d、15例、(13.8±1.6)d比较,差异均有统计学意义(P<0.05)。雾化组有2例出现声音嘶哑,5例口腔内有霉菌生长。灌洗组在治疗过程中未发现与布地奈德混悬液相关的不良反应。结论布地奈德经支气管镜注射到病变明显的支气管内,治疗儿童肺炎支原体大叶性肺炎,可以加快肺部炎症的吸收,较快地改善患儿的临床症状,缩短病程,疗效显著,未发现副作用。
Objective To investigate the effect of intrabronchial injection of budesonide suspension by bronchoscope in the treatment of children with Mycoplasma pneumonia. Methods 52 cases of children with Mycoplasma pneumoniae pneumonia in children, according to the order of treatment were divided into atomization group and lavage group, 26 cases each. Two groups of children were given basic treatment, azithromycin intravenous infusion, sequential oral treatment, combined with bacterial infection given ceftriaxone anti-infection, bronchoalveolar lavage, pleural effusion with thoracentesis drainage. The aerosolized budesonide suspension was inhaled by air compression pump. The lavage group was given Budesonide suspension by bronchoscopy for local bronchial injection. The clinical efficacy of the two groups were compared. The antipyretic time after hospitalization was observed. The improvement of chest X-ray and hospital stay after 10 days of treatment were also observed. Adverse reactions were observed. Results The antipyretic time after inpatient treatment in the lavage group was (4.7 ± 0.8) d, 23 cases (11.4 ± 1.4) days after the 10th day of treatment, 5.6 ± 1.2) d, 15 cases and (13.8 ± 1.6) d respectively. There were significant differences between the two groups (P <0.05). There were 2 cases of hoarseness in the atomization group and 5 cases of mold growth in the oral cavity. The lavage group found no adverse reactions associated with budesonide suspensions during the course of treatment. Conclusion Budesonide bronchoscopy injected into the bronchial lesions significantly, the treatment of children with Mycoplasma pneumoniae lobar pneumonia, can speed up the absorption of pulmonary inflammation, improve the clinical symptoms of children and shorten the course of the disease, the effect was significant and found no significant side effect.