支气管肺泡灌洗联合甲泼尼龙琥珀酸钠辅助治疗难治性肺炎支原体肺炎疗效及对肺功能的影响OACSTPCD

Objective:To explore the clinical efficacy of bronchoalveolar lavage(BAL)combined with methylprednisolon in the treatment of refractory Mycoplasma pneumoniae pneumonia(RMPP)and its effects on pulmonary function,and to summarize its clinical significance.Methods:A total of 96 children diagnosed with RMPP and admitted into the department of pediatric respirology in our hospital from Jan.2021 to Jun.2022 were extracted to be divided into the hormone treatment group(n=42)and combination treatment group(n=54)based on parental preference of BAL.The hormone treatment group was treated with conventional macrolides for anti-infection with small doses of methylprednisolone sodium succinate,while the combination treatment group received BAL on the basis of hormone treatment group.Cough improvement time,time to normal body temperature,time for significant absorption of pulmonary signs,length of stay and radiographic improvement of two groups were observed and compared.The pulmonary function at admission and 1 month after discharge were also analyzed.Results:After treatment,the total effective rate of the combination treatment group was 96.30％,while the hormone treatment group was 80.95％,with statistically significant difference(P＜0.05).The cough improvement time,time to normal body temperature,time for significant absorption of pulmonary signs,length of stay and radiographic improvement in the combination treatment group were shorter than those in hormone treatment group,the differences were statistically significant(P＜0.05).Among the 96 children with RMPP,91 cases(94.79％)had abnormal pulmonary function.Among the cases with abnormal pulmonary function,49 cases(49/96,51.04％)had mixed ventilatory dysfunction,25 cases(25/96,26.04％)had obstructive ventilatory dysfunction,11 cases(11/96,11.46％)had small airway dysfunction,and 6 cases(6/96,6.25％)had restrictive ventilatory dysfunction.No statistically significant differences were found in peak expiratory flow(PEF),forced expiratory volume in one second(FEV1),forced expiratory flow at 25％(FEF25％),FEF50％,and FEF75％,maximum mid-expiratory flow(MMEF),and forced vital capacity(FVC)between two groups at admission(P＞0.05).However,one month after discharge,there was statistically significant difference in pulmonary function indicators between two groups(P＜0.05),and the pulmonary function improvement of the combination treatment group was more significant than hormone treatment group.Conclusion:BAL combined with methylprednisolone sodium succinate in the treatment of RMPP has better clinical efficacy and faster lesion absorption rate compared with methylprednisolone sodium succinate alone.Over 90％of children with RMPP have abnormal pulmonary function,with mixed ventilatory dysfunction being the most common,followed by obstructive ventilatory dysfunction.BAL can accelerate the improvement of pulmonary function and promote the recovery of pulmonary function.