Study on the Efficacy of Acetylcysteine in Severe Pneumonia in Children under Electronic Bronchoscopy
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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（n = 43）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、咳嗽消失时间和合并症消失时间明显缩短（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 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 （n = 43） 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, cough disappearance time and comorbidities 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 is relatively safe. -
表 1 2组患儿临床指标比较[（$ \bar x \pm s $）/（%），n = 43]
Table 1. comparison of clinical indicators between two groups of children [（$ \bar x \pm s $）/（%），n = 43]
临床指标 对照组（n=43） 研究组（n=43） t/χ2 P 病程（d） 16.40±1.75 15.93±2.16 1.109 0.272 住院时间（d） 13.38±2.94 10.62±1.70 5.329 <0.001*** 咳嗽消失时间（d） 16.92±3.17 12.84±2.54 6.586 <0.001*** 合并症消失时间（d） 12.17±2.38 9.26±2.15 5.950 <0.001* 与对照组比较，***P < 0.001。 
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表 2 2组患儿治疗效果比较[n（%）]
Table 2. Comparison of treatment effects between two groups of children [n（%）]
组别 痊愈 显效 有效 无效 总有效率 对照组（n=43） 8（18.60） 9（20.94） 13（30.23） 13（30.23） 30（69.77） 研究组（n=43） 12（27.91） 16（37.21） 12（27.91） 3（6.98） 40（93.02） χ2 9.050 P 0.029* 与对照组比较，*P < 0.05。
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表 3 2组患儿治疗前后炎症指标水平比较（$ \bar x \pm s $）
Table 3. Comparison of inflammatory index levels before and after treatment between two groups of children （$ \bar x \pm s $）
炎症指标 对照组（n=43） 研究组（n=43） t P 白细胞计数（×109/L） 治疗前 18.75±3.92 19.12±2.84 0.501 0.618 治疗后 15.97±2.87* 12.84±2.16* 5.714 <0.001### 降钙素原（μg/L） 治疗前 4.23±1.51 4.57±1.68 0.987 0.327 治疗后 2.17±0.95* 1.35±0.63* 4.717 <0.001### C反应蛋白（mg/L） 治疗前 56.34±10.91 54.06±9.82 1.019 0.311 治疗后 20.02±3.25* 8.67±2.51* 18.125 <0.001### 白细胞介素-6（pg/mL） 治疗前 144.27±32.96 139.85±33.05 0.621 0.536 治疗后 72.94±16.82* 44.37±12.08* 9.047 <0.001### 肿瘤坏死因子-α（pg/mL） 治疗前 112.08±29.17 115.94±27.56 0.631 0.530 治疗后 60.39±15.21* 42.15±10.79* 6.414 <0.001### 与治疗前比较，*P < 0.05；对照组与研究组的比较，###P < 0.001。
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表 4 2组患儿治疗前后潮气呼吸功能比较 （$ \bar x \pm s $）
Table 4. Comparison of tidal respiratory function before and after treatment between two groups of children （$ \bar x \pm s $）
潮气呼吸功能 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。
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