目的 分析和評(píng)價(jià)乙酰半胱氨酸（NAC）肺泡灌洗聯(lián)合支氣管鏡肺泡灌洗術(shù)對(duì)兒童肺實(shí)變及肺不張的治療效果和安全性。方法 選取146例肺實(shí)變及肺不張患兒作為研究對(duì)象，分為研究組（48例，采用NAC肺泡灌洗聯(lián)合支氣管鏡肺泡灌洗術(shù)治療）和對(duì)照組（98例，采用支氣管鏡肺泡灌洗術(shù)治療）。對(duì)兩組患兒的臨床療效、治療指標(biāo)、實(shí)驗(yàn)室指標(biāo)、動(dòng)脈血?dú)庵笜?biāo)、肺功能指標(biāo)和氧合指數(shù)（OI）、血清表面活性物質(zhì)相關(guān)蛋白-A（SP-A）、氧化應(yīng)激指標(biāo)及安全性進(jìn)行對(duì)比分析。結(jié)果 研究組患兒的療效優(yōu)于對(duì)照組（P＜0.05）。研究組患兒的肺部啰音消失時(shí)間、體溫恢復(fù)時(shí)間、住院時(shí)間均短于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P＜0.001）。兩組患兒治療前實(shí)驗(yàn)室指標(biāo)、動(dòng)脈血?dú)庵笜?biāo)、肺功能指標(biāo)、OI的差異均無統(tǒng)計(jì)學(xué)意義；在灌洗治療后，兩組患兒的外周血白細(xì)胞計(jì)數(shù)（WBC）、血清C反應(yīng)蛋白（CRP）、降鈣素原（PCT）水平、動(dòng)脈二氧化碳分壓（PaCO₂）水平均較治療前降低，動(dòng)脈血氧分壓（PaO₂）、動(dòng)脈血氧飽和度（SaO₂）、第1秒用力呼氣容積（FEV₁）、用力肺活量（FVC）、FEV₁占FVC的百分比（FEV₁/FVC）、OI水平均較治療前升高，同組治療前后的差異均有統(tǒng)計(jì)學(xué)意義（P＜0.001）；研究組患兒治療后的WBC、CRP、PCT、PaCO₂水平均低于對(duì)照組，PaO₂、SaO₂、FEV₁、FCV、FEV₁/PVC、OI水平均高于對(duì)照組，兩組間的差異均有統(tǒng)計(jì)學(xué)意義（P＜0.001）。兩組患兒治療前血清SP-A水平和氧化應(yīng)激指標(biāo)的差異均無統(tǒng)計(jì)學(xué)意義；在灌洗治療后，兩組患兒血清SP-A、超氧化物歧化酶（SOD）、谷胱甘肽過氧化物酶（GSH-Px）水平均較治療前升高，血清丙二醛（MDA）水平均較治療前下降，同組治療前、后的差異均有統(tǒng)計(jì)學(xué)意義（P＜0.001）；研究組患兒治療后的血清SP-A、SOD、GSH-Px水平均高于對(duì)照組，血清MDA水平低于對(duì)照組，兩組之間的差異均有統(tǒng)計(jì)學(xué)意義（P＜0.001）。兩組不良反應(yīng)的發(fā)生率無統(tǒng)計(jì)意義。結(jié)論 針對(duì)兒童肺實(shí)變和肺不張，在支氣管鏡肺泡灌洗術(shù)治療中聯(lián)合采用NAC肺泡灌洗治療，可提升臨床療效，顯著緩解患兒炎癥反應(yīng)和氧化應(yīng)激水平，改善肺功能和動(dòng)脈血?dú)庵笜?biāo)，提升組織氧合水平，促進(jìn)肺組織順應(yīng)性恢復(fù)，不會(huì)增加治療不良反應(yīng)。

Objective To analyze and evaluate the therapeutic efficacy and safety of alveolar lavage with acetylcysteine (NAC) combined with bronchoscopic alveolar lavage in children with pulmonary solid changes and pulmonary atelectasis. Methods A total of 146 children with pulmonary solid changes and pulmonary atelectasis were selected as study subjects and divided into study group (48 cases, treated with NAC alveolar lavage combined with bronchoscopic alveolar lavage) and control group (98 cases, treated with bronchoscopic alveolar lavage). The therapeutic efficacy and safety of the children in two groups were compared and analyzed. Results The efficacy of the children in study group was better than that of control group (P < 0.05). The disappearance time of lung rales, temperature recovery time and hospitalization time of the children in the study group were shorter than those in control group, and the differences were statistically significant (P < 0.001). The differences in laboratory indexes, arterial blood gas indexes, pulmonary function indexes, and OI before treatment were not statistically significant between two groups. After lavage treatment, the WBC, CRP, PCT level, and PaCO₂ level of the children in two groups were lower than those before treatment, and PaO₂, SaO₂, FEV1, FCV, FEV1/PVC, and OI levels were all higher than before treatment, and the differences between the same groups before and after treatment were statistically significant (P < 0.001). The WBC, CRP, PCT, and PaCO₂ levels of the children in study group were lower than those of control group, and the levels of PaO₂, SaO₂, FEV1, FCV, FEV1/PVC, and OI were higher than those of control group, with statistically significant differences between both groups (P < 0.001). The levels of WBC, CRP, PCT, and PaCO₂ were lower than those of control group after treatment. The differences were statistically significant (P < 0.001). The differences in serum SP-A levels and oxidative stress indicators before treatment were not statistically significant between two groups. After lavage treatment, serum SP-A, SOD, and GSH-PX levels of two groups were higher than before treatment, and serum MDA levels were lower than before treatment, and the differences between the same groups before and after treatment were statistically significant (P < 0.001). Serum SP-A, SOD, and GSH-PX levels of the children in study group were higher than before treatment, and serum MDA levels decreased compared to the pre-treatment period, and the differences between the same groups before and after treatment were statistically significant (P < 0.001). Serum SP-A, SOD and GSH-PX levels of children in study group were higher than those of control group, and serum MDA levels were lower than those of control group, and the differences between two groups were statistically significant (P < 0.001). The incidence of adverse reactions in two groups was not statistically significant. Conclusion For children with pulmonary solid lesions and pulmonary atelectasis, the combined use of NAC alveolar lavage treatment in bronchoscopic alveolar lavage treatment can enhance clinical efficacy, significantly alleviate the level of inflammatory response and oxidative stress in children, improve lung function and arterial blood gas index, enhance the level of tissue oxygenation, and promote the restoration of the compliance of the lung tissues, and will not increase the adverse reactions of the treatment.

R974