不同时机纤维支气管镜联合多西环素对难治性肺炎支原体肺炎患儿的疗效研究

Efficacy of fiberoptic bronchoscopy combined with doxycycline at different timings for refractory Mycoplasma pneumoniae pneumonia in children

摘要:

目的 探讨不同时机纤维支气管镜联合多西环素对难治性肺炎支原体肺炎患儿的疗效。方法 选取2023年2月—2024年12月成都市第二人民医院收治的123例难治性肺炎支原体肺炎患儿。采用随机数字表法分为对照组、早期干预组和晚期干预组，各41例。对照组接受多西环素治疗，早期干预组在对照组基础上于入院3 d内接受纤维支气管镜治疗，晚期干预组在对照组基础上于入院3 d后接受纤维支气管镜治疗。比较3组患儿的症状改善时间，于治疗2周后比较临床疗效和治疗前后的炎症因子水平、血气指标，记录不良反应发生情况。结果 早期干预组体温恢复时间、肺部啰音消失时间和咳嗽消失时间均比对照组和晚期干预组缩短（P < 0.05）。对照组、早期干预组与晚期干预组治疗有效率比较，差异有统计学意义（P < 0.05）。早期干预组治疗前后C反应蛋白（CPR）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、二氧化碳分压（PaCO₂）、血氧分压（PaO₂）和pH的差值均大于晚期干预组和对照组（P < 0.05）。对照组、早期干预组与晚期干预组不良反应发生率比较，差异无统计学意义（P < 0.05）。结论 早期纤维支气管镜联合多西环素治疗可提高难治性肺炎支原体肺炎患儿的临床疗效。

Abstract:

Objective To investigate the efficacy of fiberoptic bronchoscopy combined with doxycycline administered at different timings in children with refractory Mycoplasma pneumoniae pneumonia (RMPP).Methods A total of 123 RMPP children admitted to Chengdu Second People's Hospital from February 2023 to December 2024 were randomized into three groups (n = 41 each) using a random number table: control group (doxycycline alone), early intervention group (doxycycline + fiberoptic bronchoscopy within 3 days of admission), and late intervention group (doxycycline + fiberoptic bronchoscopy after 3 days of admission). Symptom improvement time, clinical efficacy, pre- and post-treatment inflammatory markers, blood gas parameters, and adverse reactions were compared at 2 weeks.Results The early intervention group showed shorter fever resolution time, lung rales disappearance time, and cough cessation time compared to the control and late intervention groups (P < 0.05). Significant differences in clinical efficacy rates were observed among the three groups (P < 0.05). Greater changes in CRP, TNF-α, IL-6, PaCO?, PaO?, and pH were observed in the early intervention group versus the other two groups (P < 0.05). No statistically significant difference in adverse reaction rates was found (P < 0.05).Conclusion Early fiberoptic bronchoscopy combined with doxycycline improves clinical outcomes in RMPP children.