肺炎支原体感染大叶性肺炎患儿常规通气与脉冲振荡肺功能特点分析

doi:10.3969/j.issn.1000-8535.2024.07.005

摘要/Abstract

摘要： 目的探究肺炎支原体（MP）感染大叶性肺炎患儿常规通气、脉冲振荡肺功能特点。方法将2022年5月—2023年5月广州市妇女儿童医疗中心收治的90例MP感染大叶性肺炎患儿为观察组,通气体检健康儿童50例为对照组,依据病变将累及多肺叶作为观察A组（10例）,累及单肺叶作为观察B组（80例）。均接受常规通气与脉冲振荡肺功能测定,观察测定结果,以此为基础,分析肺功能特点。结果观察组各常规通气肺功能指标测定结果均低于对照组健康儿童,差异有统计学意义（P<0.05）。观察组R5、R20的实测值/预计值高于对照组,X5实测值低于对照组,差异有统计学意义（P<0.05）。气道阻力指标与肺功能呈负相关关系（P<0.05）。观察组两组最大肺活量（VCMAX）、呼气流量峰值（PEF）、用力肺活量（FVC）75%、FVC50%、FVC25%的实测值/预计值差异无统计学意义,观察A组患儿FVC、FEV₁的实测值/预计值低于观察B组患儿,差异有统计学意义（P<0.05）。两组患儿脉冲振荡肺功能对比差异无统计学意义（P>0.05）。90例患儿中,常规通气异常患儿12例,患儿治疗前后VCMAX、FVC75%、FVC50%的实测值/预计值差异无统计学意义,患儿治疗前FVC、FEV₁、PEF、FVC25%的实测值/预计值均低于治疗后,差异有统计学意义（P<0.05）。结论常规通气与脉冲振荡相关性良好,气道阻力对VCMAX及FVC具有反向作用,MP感染大叶性肺炎主要表现为小气道通气功能受损,气道阻力升高。

关键词: 肺炎支原体感染, 大叶性肺炎, 常规通气, 脉冲振荡, 肺功能

Abstract: Objective To explore the lung function characteristics of routine ventilation and pulse oscillation in children with lobar pneumonia infected with Mycoplasma pneumoniae（MP）．Methods Ninety children with MP infected lobar pneumonia admitted to Guangzhou Women and Children's Medical Center from May 2022 to May 2023 were selected as the observation group,and 50 healthy children undergoing ventilation examination were selected as the control group．Based on the lesion,cases with multi lobar involvement were selected as the observation group A（10 cases）,cases with single lobar involvement were selected as the observation group B（80 cases）．All patients underwent routine ventilation and pulse oscillation received pulmonary function measurement,and the measurement results were observed．Based on this,the characteristics of lung function were analyzed．Results The results of routine ventilation lung function indicators in the observation group were lower than those in the control group,and the difference was statistically significant（P<0.05）．The measured/expected values of R5 and R20 in the observation group were higher than those in the control group,while the measured values of X5 were lower than those in the control group,with statistical significance（P<0.05）．There is a negative correlation between airway resistance indicators and lung function（P<0.05）．The measured/predicted values of vital capacity max（VCMAX）,peak expiratory flow（PEF）,forced vital capacity（FVC）75%,FVC50%,and FVC25% in the observation group were not with statistically significant difference．The measured/predicted values of FVC and FEV₁ in the observation group A were lower than those in the observation group B,and the difference was statistically significant（P<0.05）．There was no statistically significant difference in pulmonary function between the two groups of pediatric patients with pulse oscillation（P>0.05）．Among the 90 patients,12 had abnormal conventional ventilation．The measured/predicted values of VCMAX,FVC75%,and FVC50% before and after treatment were not significantly different．The measured/predicted values of FVC,FEV₁,PEF,and FVC25% before treatment were lower than those after treatment,and the difference was statistically significant（P<0.05）．Conclusions There is good correlation between conventional ventilation and pulse oscillation．Airway resistance has a reverse effect on VCMAX and FVC．MP infected lobar pneumonia is mainly characterized by impaired small airway ventilation function and increased airway resistance．

Key words: Mycoplasma pneumoniae infection, lobar pneumonia, routine ventilation, pulse oscillation, pulmonary function

江剑民, 沈慧玲, 何艳冰, 王洪清, 梁薇. 肺炎支原体感染大叶性肺炎患儿常规通气与脉冲振荡肺功能特点分析[J]. 广州医药, 2024, 55(7): 730-734.

JIANG Jianmin, SHEN Huiling, HE Yanbing, WANG Hongqing, LIANG Wei. Analysis of pulmonary function characteristics of routine ventilation and pulse oscillation in children with lobar pneumonia infected with Mycoplasma pneumoniae[J]. Guangzhou Medical Journal, 2024, 55(7): 730-734.

参考文献

[1] 庄瑞梅,王琴,王珂,等.肺炎支原体感染大叶性肺炎患儿常规通气与脉冲振荡肺功能特点分析[J].中国实用儿科杂志,2022,37(3):214-220.
[2] 吉祥灵,雷智贤,吴守业,等.儿童肺炎支原体感染支气管肺炎与大叶性肺炎临床及血液学特征[J].中华医院感染学杂志,2021,31(2):281-285.
[3] 王雪,高密密,尹力,等.儿童肺炎支原体肺炎并发大叶性肺炎的危险因素[J].中华医院感染学杂志,2021,31(2):277-280.
[4] 赵阳,贾玉涛,马国瑞,等.儿童大叶性肺炎经纤维支气管镜治疗后肺功能恢复情况[J].贵州医药,2023,47(3):434-435.
[5] 褚旭丽,吴玲玲,李雁.肺炎支原体感染对患儿外周血T淋巴细胞亚群及肺功能的影响[J].中国妇幼保健,2021,36(3):596-598.
[6] 刘怀彬,闵婕,郝琳,等.2013—2018年徐州地区住院儿童肺炎支原体流行特点[J].徐州医科大学学报,2021,41(7):543-546.
[7] 李华,张晓莉.难治性肺炎支原体肺炎患儿临床特点及疗效分析[J].血栓与止血学,2022,28(2):235-236.
[8] 袁巧云. 注射用甲泼尼龙琥珀酸钠联合阿奇霉素对儿童支原体大叶性肺炎症状改善及血清炎性因子水平的影响[J].中国药物与临床,2021,21(24):4041-4043.
[9] 许铖,路燕,徐明,等.肺炎支原体抗体联合降钙素原对小儿支原体肺炎感染的诊断价值[J].中国妇幼健康研究,2022,33(2):72-75.
[10] 袁娟,白慧萍,徐鹏飞,等.MSCT检查对儿童肺炎支原体肺炎与肺炎支原体合并肺炎链球菌感染肺炎的鉴别诊断价值分析[J].中国CT和MRI杂志,2021,19(8):72-73,76.
[11] 王维,林书祥,王露,等.天津地区儿童感染肺炎支原体基因型特征分析及其临床特点[J].中华微生物学和免疫学杂志,2021,41(5):380-387.
[12] 张虹,薛喜强,朱天怡,等.咳嗽变异性哮喘合并肺炎支原体感染患儿哮喘控制测试评分与肺功能状况研究[J].临床军医杂志,2022,50(11):1159-1162.
[13] 谢勇,郭丽丽.支气管哮喘合并肺炎支原体感染患儿糖皮质激素受体α,βmRNA表达检测及其与血清炎症因子,肺功能相关性分析[J].陕西医学杂志,2022,51(9):1142-1145.
[14] 童仁香,陈倩,常甄填,等.阿奇霉素序贯治疗联合硫酸特布他林对肺炎支原体肺炎患儿肺功能和血清IL-6,CRP,PCT水平的影响[J].现代生物医学进展,2021,21(16):3160-3163.
[15] 顾剑华,金晓群,徐艳娜,等.支原体肺炎伴喘息儿童肺功能,FeNO水平及Th1/Th2免疫平衡状态的变化[J].海南医学,2022,33(5):591-594.