Therapeutic Effect Of Early Bronchoscopy On Severe Mycoplasma Pneumonia With Atelectasis In Children

Background:Mycoplasma pneumoniae(MP)is an important pathogen of community-acquired pneumonia(CAP).Children are generally susceptible.MP is the common cause of respiratory infections in children.Although Mycoplasma pneumoniae pneumonia(MPP)is usually considered a self-limiting disease,it still causes some complication.Extrapulmonary complications such as arthritis,pericarditis and encephalitis etc.It can even develop into serious complications such as life-threatening severe pneumonia,acute respiratory distress syndrome and necrotizing pneumonia.Currently,severe Mycoplasma pneumoniae pneumonia have been reported more and more.The most common clinical pulmonary complication is atelectasis.With the extensive development of flexible bronchoscopy technology in pediatrics,bronchoalveolar lavage(BAL)has gradually been recognized in the examination and treatment of respiratory diseases in children.BAL can not only improve the clinical manifestations of infectious atelectasis in children,but also promote the repair of lung injury and the absorption of chest imaging.However,there is no relevant clinical report on the optimal timing of BAL treatment for children with severe SMPP and atelectasis and the effects of different treatment timings on the imaging recovery of atelectasis.Therefore,we make the following clinical studies on this issue.Objective : The focus of this study is the efficacy of early bronchoscopy intervention on severe mycoplasma pneumoniae pneumonia with atelectasis in children.Compare the therapeutic effect of bronchoscopy in different courses of diseases.Methods : In this study,children diagnosed severe MPP with atelectasis in the Children’s Hospital of Chongqing Medical University from January 2017 to February 2018 were selected as the research subjects.1.Children with severe atelectasis pneumonia agreed with BAL at 1 week of disease course were considered as Group A,and those whose guardians rejected BAL during the same period were considered as Group B.2.Chest imaging was reviewed at 2 weeks of disease,and children with atelectasis who did not fully recovered were grouped again,Chest imaging was reviewed at 2 weeks of disease,and children with atelectasis who did not improve completely were grouped again;Those who do not want the second BAL(group A1),those who agree to the second BAL(group A2);those who agree to the first BAL(group B1),and those who still do not want BAL(group B0).3.Chest imaging was performed again at 1 month,and the recovery of atelectasis among children in each group was compared.Result: 1.Research object :A total of 197 children were included in group A,including 101 males(51.27%)and 96 females(48.73%).The age ranged from 1 year and 3 months to 11 years and 7 months,with a median age of 6 years and 10 months.A total of 133 children were included in group B,including 71 males(53.38%)and 62 females(46.62%).The age ranged from 1 year and 1 month to 13 years and 2 months,with a median age of 6 years and 1 month.There was no significant difference between the 2 groups(P>0.05).Number of patients with extrapulmonary complications such as liver injury,myocardial injury and toxic encephalopathy:79 cases in group A and 54 cases in group B.The number of patients with pleural effusion: 40 cases in group A and 31 cases in group B.There was no significant difference between the two groups(P>0.05).2.Chest imaging was reviewed at 2 weeks,and the recovery of atelectasis in group A was better than that in group B.(P<0.05)3.Chest imaging was reviewed 1 month after the disease,The recovery of atelectasis in group A2 was better than the other three groups(P<0.05),group A1 was better than group B0(P=0.007<0.05),group A1 was better than group B1(P<0.001),but group B0 and group B1 chest There was no statistical difference in film recovery(P=0.187>0.05).4.Safety: In all cases in this study,no serious complications occurred during or after bronchoscopy.Conclusion: 1.Early bronchoscopy intervention can promote the imaging recovery of severe mycoplasma pneumonia with atelectasis.the best intervention time is 1-2 weeks after the disease.2.If the recovery of atelectasis after the first time BAL did not is not satisfied,treatment with BAL again can still promote atelectasis absorption.