| Objective:To investigate the clinical efficacy and safety of electric fiberobronchoscopy intervention at different times in children with refractory mycoplasma pneumoniae pneumonia,to analyze the risk factors affecting chest imaging absorption,and to explore the best time for bronchoscopy intervention during hospitalization.Methods:Retrospective analysis of 142 cases of children diagnosed with refractory Mycoplasma Pneumoniae Pneumonia in the Children’s Hospital of Soochow University from January 2015 to January 2018.Based on the intervention time of bronchoscopy,the patients were divided into early intervention group(course of 5-10 days),medium-term intervention group(course of 11～15 days),the late intervention group(course of 16 days or more),and to analyze the general information,clinical manifestation and laboratory examination,radiological manifestation of the three groups.According to whether postoperative imaging is absorbed within three weeks,we divide 142 patients into absorption group and non-absorption group,comparing two groups of children with general information,clinical manifestation,laboratory examination,and radiological manifestation.We used multivariate Logistic regression analysis to analyze the possible risk factors with P<0.05 between the two groups.ROC curve analysis of independent risk factors was performed,and P<0.05 was considered statistically significant.Results:1.There were no significant differences in age,gender,CRP,PCT,LDH and first chest X-ray integral between the three groups.The hospitalization time of the three groups was 8.5(7.0～11.0)days,11.0(9.0～13.0)days,and 11.0(10.0～15.0)days,and the hospitalization time of the early group was shorter than that of the middle group and the late group(P=0.000 and P=0.004,respectively).The fever period of the three groups was 7.0(5.0-8.0)days,10.0(7.0-12.0)days,and 10.0(7.0-15.0)days,and the fever period of the early group was significantly shorter than that of the middle and late groups(P=0.000 and P=0.001,respectively).The disappearance time of cough in the three groups was 6.0(4.0～8.3)days,8.0(6.0～10.0)days,and 8.0(7.0～9.0)days,and the disappearance time of cough in the early group was significantly shorter than that of the middle and late groups(P=0.001 and P=0.003,respectively).2.There were 4 cases(2.8%)with hypoxia after operation,4 cases(2.8%)with fever,4 cases(2.8%)with tension purpura,2 cases(1.4%)with cough.There were no significant differences in adverse reactions between the three groups.3.There were 31 cases(62.0%)in the imaging absorption group and 19 cases(38.0%)in the non-absorption group in the early group,27 cases(40.9%)in the absorption group and 39 cases(59.1%)in the non-absorption group in the middle group,9 cases(34.6%)in the absorption group and 17 cases(65.4%)in the non-absorption group in the late group,and the difference was statistically significant(P=0.029).4.Among 142 children undergoing bronchoscopy,67 cases showed imaging absorption within 3 weeks,while 75 cases did not,which was related to the fever peak in the course of the disease,bronchoscope intervention time,fever period,hormone-insensitivity,LDH,D-dimer,first chest X-ray integral,atelectasis,and sputum suppository formation(P<0.05).Logistic regression analysis was performed on possible risk factors with statistical significance(P<0.05)in the comparison between the absorption group and the non-absorption group,and the results showed that hormone-insensitivity,bronchoscope intervention time,D-dimer,atelectasis and sputum suppository formation were independent risk factors(P<0.05).5.Based on the OR value of significant risk factors,we assigned 1 point for bronchoscope intervention days longer than 11.5 days,D-dimer of higher than 1174 ug/L,sputum suppository formation and two points for hormone-insensitivity and atelectasis.On the basis of the predicted score,2 risk strata were identified:high risk,with scores of 4-6,the absorption rate was 3.7%and low risk,with scores of 0-3,the absorption rate was 57.40 after 3 weeks.Conclusions:1.Bronchoscopy intervention has a significant effect in the treatment of children with refractory Mycoplasma Pneumoniae Pneumonia,At the same time there were few adverse reactions.2.Early intervention with bronchoscopy has an important effect on shortening the hospitalization time,reducing the duration of fever and cough,and promoting chest imaging absorption.3.Hormone insensitivity,bronchoscopy intervention time,D-dimer,atelectasis,and sputum formation are associated with slow imaging of chest imaging in children with RMPP.4.Bronchoscopy intervention is helpful for the recovery of chest imaging in children with a course of 11.5 days. |
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