Study on the Application of Acetylcysteine Solution for Retained Perfusion Inhalation under Electronic Bronchoscopy in the Treatment of Severe Bacterial Pneumonia in Children
-
摘要:
目的 探索电子支气管镜下保留灌注吸入用乙酰半胱氨酸溶液治疗儿童重症细菌性肺炎的临床疗效。 方法 将昆明市儿童医院呼吸内科于2021年1月1日至2022年12月31日收治的86例重症细菌性肺炎患儿随机分为对照组和研究组（n = 43），对照组患儿均接受电子支气管镜下生理盐水肺泡灌洗治疗，研究组在肺泡灌洗治疗结束后保留灌注吸入用乙酰半胱氨酸溶液治疗，比较2组患儿临床治疗效果、炎症指标、潮气呼吸功能和不良反应。 结果 经治疗后，与对照组相比，研究组患儿住院时间及咳嗽消失时间明显缩短（P < 0.05），总有效率明显高于对照组（P < 0.05）；研究组患儿白细胞计数、降钙素原、C反应蛋白、白细胞介素-6、肿瘤坏死因子-α水平均明显低于对照组（P < 0.05）；研究组患儿潮气量、达峰时间比、达峰容积比水平均明显高于对照组（P < 0.05）；2组患儿的药物不良反应比较差异无统计学意义（P > 0.05）。 结论 电子支气管镜下保留灌注吸入用乙酰半胱氨酸溶液可明显改善重症细菌性肺炎患儿的临床症状、炎症指标及肺功能，且安全性较好。 Abstract:Objective To explore the clinical efficacy of acetylcysteine solution retained perfusion inhalation treatment under electronic bronchoscopy in children with severe bacterial pneumonia. Methods To explore the clinical efficacy of acetylcysteine solution retained perfusion inhalation treatment under electronic bronchoscopy in children with severe bacterial pneumonia. Methods: From January 1, 2021 to December 31, 2022, 86 children with severe bacterial pneumonia treated in the Department of Respiratory Medicine of Kunming Children’ s Hospital were randomly divided into a control group and a study group （n = 43）. The children in the control group received electronic bronchoscopy under physiological saline pulmonary alveolar lavage treatment. The study group received acetylcysteine solution treatment retained after the end of the pulmonary lavage treatment. The clinical treatment effects, inflammatory indicators, tidal breathing function, and adverse reactions of the two groups were compared. Results After treatment, compared with control group, the hospitalization time and cough disappearance time of children in study group were significantly shortened （P < 0.05）, and the total effective rate of study group was significantly higher than that of control group （P < 0.05）. The levels of white blood cell count, procalcitonin, C-reactive protein, interleukin-6, and tumor necrosis factor-α of study group were significantly lower than those of control group （P < 0.05）. The tidal volume per kilogram of body weight, peak time ratio, and peak volume ratio levels of study group were significantly higher than those of control group （P < 0.05）.There was no statistically significant difference in the adverse drug reactions between two groups （P > 0.05）. Conclusion Under electronic bronchoscopy, preserving perfusion and inhaling acetylcysteine solution can significantly improve the clinical symptoms, inflammatory indicators, and lung function of children with severe bacterial pneumonia, and it was relatively safe. -
表 1 2组患儿一般资料比较[（$ \bar x \pm s $）/（%），n = 43]
Table 1. Comparison of General Information between Two Groups of Children[（$ \bar x \pm s $）/（%），n = 43]
相关指标 对照组（n=43） 研究组（n=43） t/χ2 P 病程（d） 16.40±1.75 15.93±2.16 1.109 0.272 住院时间（d） 13.38±2.94 10.62±1.70 5.329 <0.001*** 咳嗽消失时间（d） 16.92±3.17 12.84±2.54 6.586 <0.001*** 合并症 胸腔积液 14（32.56） 12（27.91） 0.699 0.705 心包积液 8（18.60） 9（20.93） 肝脾肿大 11（25.58） 15（34.88） 与对照组比较，***P < 0.001。 
下载: 导出CSV
表 2 2组患儿治疗效果比较（n，%）
Table 2. Comparison of Treatment Effects between Two Groups of Children （n，%）
组别 痊愈 显效 有效 无效 总有效率 对照组（n=43） 8（18.60） 9（20.94） 13（30.23） 13（30.23） 30（69.77） 研究组（n=43） 12（27.91） 16（37.21） 12（27.91） 3（6.98） 40（93.02） χ2 9.050 P 0.029* 与对照组比较，*P < 0.05。
下载: 导出CSV
表 3 2组患儿治疗前后炎症指标水平比较（$ \bar x \pm s $）
Table 3. Comparison of Inflammatory Index Levels before and after Treatment between Two Groups of Children （$ \bar x \pm s $）
对照组（n=43） 研究组（n=43） t P 白细胞计数（×109/L） 治疗前 18.75±3.92 19.12±2.84 0.501 0.618 治疗后 15.97±2.87* 12.84±2.16* 5.714 <0.001### 降钙素原（μg/L） 治疗前 4.23±1.51 4.57±1.68 0.987 0.327 治疗后 2.17±0.95* 1.35±0.63* 4.717 <0.001### C反应蛋白（mg/L） 治疗前 56.34±10.91 54.06±9.82 1.019 0.311 治疗后 20.02±3.25* 8.67±2.51* 18.125 <0.001### 白细胞介素-6（pg/mL） 治疗前 144.27±32.96 139.85±33.05 0.621 0.536 治疗后 72.94±16.82* 44.37±12.08* 9.047 <0.001### 肿瘤坏死因子-α（pg/mL） 治疗前 112.08±29.17 115.94±27.56 0.631 0.530 治疗后 60.39±15.21* 42.15±10.79* 6.414 <0.001### 与治疗前比较，*P < 0.05；对照组与研究组的比较，###P < 0.001。
下载: 导出CSV
表 4 2组患儿治疗前后潮气呼吸功能比较 （$ \bar x \pm s $）
Table 4. Comparison of Tidal Respiratory Function before and after Treatment between Two Groups of Children （$ \bar x \pm s $）
对照组（n=43） 研究组（n=43） t P 每公斤体重潮气量（mL/kg） 治疗前 7.15±1.20 7.18±1.39 0.107 0.915 治疗后 7.86±1.52* 8.94±1.67* 3.316 0.002## 达峰时间比（%） 治疗前 21.67±6.24 22.05±6.37 0.279 0.781 治疗后 27.31±5.08* 31.12±5.37* 3.380 0.001## 达峰容积比（%） 治疗前 18.79±4.92 19.05±5.13 0.240 0.811 治疗后 25.34±5.71* 30.86±5.54* 4.550 <0.001### 与治疗前比较，*P < 0.05；对照组与研究组的比较，##P < 0.01、###P < 0.001。
下载: 导出CSV
-
[1] Rueda Z V,Aguilar Y,Maya M A,et al. Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents[J]. BMC Pediatr,2022,22(1):169. doi: 10.1186/s12887-022-03235-z [2] Zhou Y,Wang J,Chen W,et al. Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory mycoplasma pneumoniae pneumonia[J]. BMC Infect Dis,2020,20(1):633. doi: 10.1186/s12879-020-05356-1 [3] Thea D M,Seidenberg P,Park D E,et al. Limited utility of polymerase chain reaction in induced sputum specimens for determining the causes of childhood pneumonia in resource-poor settings: findings from the Pneumonia Etiology Research for Child Health (PERCH) Study[J]. Clin Infect Dis,2017,64(suppl 3): S289-300. [4] Chen D,Cao L,Li W,et al. Etiological and clinical characteristics of severe pneumonia in pediatric intensive care unit (PICU)[J]. BMC Pediatr,2023,23(1):362. doi: 10.1186/s12887-023-04175-y [5] Wang H,Li X,Zheng Y,et al. Concordance in pathogen identification at the upper and lower respiratory tract of children with severe pneumonia[J]. BMC Infect Dis,2023,23(1):170. doi: 10.1186/s12879-023-08127-w [6] Zhang X,Yu Y. Severe pediatric mycoplasma pneumonia as the cause of diffuse alveolar hemorrhage requiring veno-venous extracorporeal membrane oxygenation: A case report[J]. Front Pediatr,2022,10:925655. [7] Xu X H,Fan H F,Shi T T,et al. Influence of the timing of bronchoscopic alveolar lavage on children with adenovirus pneumonia: A comparative study[J]. BMC Pulm Med,2021,21(1):363. doi: 10.1186/s12890-021-01708-y [8] Wang L,Xie Q,Xu S,et al. The role of flexible bronchoscopy in children with mycoplasma pneumoniae pneumonia[J]. Pediatr Res,2023,93(1):198-206. doi: 10.1038/s41390-021-01874-z [9] Wu X,Lu W,Sang X,et al. Timing of bronchoscopy and application of scoring tools in children with severe pneumonia[J]. Ital J Pediatr,2023,49(1):44. doi: 10.1186/s13052-023-01446-3 [10] Wang Y,Liu K,Chen C,et al. Acetylcysteine and budesonide for the treatment of refractory mycoplasma pneumoniae pneumonia in children: A clinical observation[J]. Ital J Pediatr,2023,49(1):80. doi: 10.1186/s13052-023-01491-y [11] Liu H,Wang W,Gao X,et al. Comparison of the efficacy of ambroxol hydrochloride and N -acetylcysteine in the treatment of children with bronchopneumonia and their influence on prognosis[J]. Exp Ther Med,2020,20(6):130. [12] 中华人民共和国国家卫生健康委员会. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中国实用乡村医生杂志,2019,26(4):6-13. [13] 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组,中国医师协会儿科医师分会内镜专业委员会,中国医师协会内镜医师分会儿科呼吸内镜专业委员会,等. 中国儿科可弯曲支气管镜术指南(2018年版)[J]. 中华实用儿科临床杂志,2018,33(13):983-989. doi: 10.3760/cma.j.issn.2095-428X.2018.13.006 [14] Zhu Z,Zhang T,Guo W,et al. Clinical characteristics of refractory Mycoplasma pneumoniae pneumonia in children treated with glucocorticoid pulse therapy[J]. BMC Infect Dis,2021,21(1):126-133. doi: 10.1186/s12879-021-05830-4 [15] Zhang H F,Zhang X,Sha Y X,et al. Value of sTREM-1 in serum and bronchoalveolar lavage fluid,APACHE II score,and SOFA score in evaluating the conditions and prognosis of children with severe pneumoniaJ. Zhongguo Dang Dai Er Ke Za Zhi,2020,22(6): 626-631. [16] GBD 2015 LRICollaborators. Estimates of the global,regional,and national morbidity,mortality,and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the global burden of disease study 2015[J]. Lancet Infect Dis,2017,17(11):1133-1161. doi: 10.1016/S1473-3099(17)30396-1 [17] Tong L,Huang S,Zheng C,et al. Refractory mycoplasma pneumoniae pneumonia in children: early recognition and management[J]. J Clin Med,2022,11(10):2824-2837. doi: 10.3390/jcm11102824 [18] Zhang Y,Chen Y,Chen Z,et al. Effects of bronchoalveolar lavage on refractory Mycoplasma pneumoniae pneumonia[J]. Respir Care,2014,59(9):1433-1439. doi: 10.4187/respcare.03032 [19] Jing Liu,Hui-Rong Zhao,Hua-Li Wei,et al. Efficacy of bronchoalveolar lavage as adjunct therapy in the treatment of neonatal severe pneumonia: a prospective case-control study[J]. Journal of Tropical Pediatrics,2020,66(5):528-533. doi: 10.1093/tropej/fmaa010 [20] Paraskevas T,Kantanis A,Karalis I,et al. N-acetylcysteine efficacy in patients hospitalized with COVID-19 pneumonia: a systematic review and meta-analysis[J]. Rom J Intern Med,2023,61(1):41-52. [21] Y ü cel G,Zhao Z,El-Battrawy I,et al. Lipopolysaccharides induced inflammatory responses and electrophysiological dysfunctions in human-induced pluripotent stem cell derived cardiomyocytes[J]. Sci Rep,2017,7(1):2935. doi: 10.1038/s41598-017-03147-4 [22] Stravitz R T,Sanyal A J,Reisch J,et al. Effects of N-acetylcysteine on cytokines in non-acetaminophen acute liver failure: potential mechanism of improvement in transplant-free survival[J]. Liver Int,2013,33(9):1324-1331. doi: 10.1111/liv.12214 [23] Zhang R H,Li C H,Wang C L,et al. N-acetyl-l-cystine (NAC) protects against H9N2 swine influenza virus-induced acute lung injury[J]. Int Immunopharmacol,2014,22(1):1-8. doi: 10.1016/j.intimp.2014.06.013 [24] Tarique H,Bie T,Yin Y,et al. Oxidative stress and inflammation: What polyphenols can do for us?[J]. Oxid Med Cell Longev,2016,2016:7432797. [25] Chen H,Ma N,Song X,et al. Protective effects of N-Acetylcysteine on lipopolysaccharide-induced respiratory inflammation and oxidative stress[J]. Antioxidants (Basel),2022,11(5):879. doi: 10.3390/antiox11050879 [26] 张春玲,冯梦杰. 乙酰半胱氨酸辅助治疗重症支气管肺炎患儿的疗效及对潮气呼吸肺功能、免疫功能的影响[J]. 临床研究,2024,32(1):102-105. [27] Jannatifar R,Parivar K,Roodbari N H,et al. Effects of N-acetyl-cysteine supplementation on sperm quality,chromatin integrity and level of oxidative stress in infertile men[J]. Reprod. Biol. Endocrinol,2019,17(1):24. doi: 10.1186/s12958-019-0468-9 -
