| BackgroundInfantile pneumonia is a common disease in hospital, with a very high incidence rate, which was mainly caused by bacteria, virus or myoplasma infection. The main clinical manifestations of this patient is fever, cought, sputum, etc. These patients need close observation and treatment, because infantile pneumonia is easy to recurrent, or change into infantile refractory pneumonia, which is bad to children,s growth and development. Infantile refractory pneumonia is characterized by sereve condition, long pathogenesis and bad result to conventional treatment, and leads to complications easily, damaging the nervous system and circulatory system. So Infantile refractory pneumonia also is a major clinical problem.30 years ago, Bronchofibroscope was used in childhood respiratory disease first time. Since then, child bronchofibroscope developed gradually, from a tool of morphological examination developed to a tool of respiratory disease treatment, especially bronchoalveolar lavage by bronchofibroscope, which is a new and efficient therapeutic method to infantile refractory pneumonia. But there no comparative research on bronchoalveolar lavage by bronchofibroscope.ObjectiveTo study the therapeutic effect of lavage by bronchofibroscope in treatment of children refractory pneumonia.MethodsAll 48 children patients were randomly divided into two subgroups: experimental group (n=26,males:16,females:10,age:6.2±1.9y) and control group (n=22,males:14,females:8,age:6.8±2.1y). The experimental group was treated with lavage by bronchofibroscope and routine medical treatment, but the control group treated with routine medical treatment only. Compared the effective rate between the two groups.According to the actual illness and the individual development differences of the patients,we dicided to choose the most optimal bronchofibroscope which completely fited the trachea. Children above 8 years were treated with BAL in the local anesthesia;others under 8 years were treated with BAL in ETGA .All of the patients were applied to abrosia but infused some glucose solution during the eight hours before the operation .All of the patients were injected atropine 0.01～ 0.02mg/kg,which could clean up the respiratory secretions.According to the drift of the cytology for detection technical specifications about BAL-F which was formulate by the CMA,we focused on the refractory pneumonia focuses with more secretions and serious inflammation.BAL had not been done more times in the target points until the secretion be sucked clean and the BALF be clear.Then lesions lobectomy were flushed 3-5 times with the NS that were dissolved the sensitive antibiotics and in 37℃.After the lesions lobectomy had been clean the bilateral pulmonary were checked and the BALF. thoroughly epispaticed .ResultsThe experimental group was consisted of 29 cases of BAL, amongst those 3 patients were treated with BAL 2 times,the others were treated only once.22 cases (84.62%) were effective in the experiment group, while only 12 cases (54.55%) were effective in the control group. There was a significant diference between the two groups(P <0.05). The average therapeutic time of the experimental group was (9±2.1) d, while the average therapeutic time of the control group was (15.6±3.8)d. The time for controlling the pneumonia in the experimental group was significantly shorter than that in the control group(P <0.05).ConclusionThe BAL therapy can sufficientlly elimimate the respiratory secretions, release bronchinal obstrucion, improve pulmonary ventilation and raise drug concentration of refractory pneumonia focus. All these methods will improve clinical therapeutic effects, reduce clinical treatment time. So, BAL is a safe and useful therapy for children refractory pneumonia. |
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