Clinical Characteristics Of Refractory Pneumonia In 295 Childrens

Backgrounds: Refractory pneumonia is a severe problem in pediatric clinics.For successful diagnosis and treatment of severe、protracted or refractory pneumonia,it is critical to understanding the clinical features of refractory pneumonia,determining the pathogen,and targeted treatment.In our country,there is few reports on the clinical characteristics of refractory pneumonia.Objectives: In order to understand the clinical characteristics of refractory pneumonia,and to provide references for the diagnosis and treatment of children with refractory pneumonia in clinics,we retrospective analyze the clinical data of 295 children with refractory pneumonia.Methods: Using retrospective research methods,selecting from September 1,2019 to December 31,2020,aged between 28 days and 14 years old,hospitalized in Kunming Children’s Hospital due to respiratory infections,diagnosed as refractory pneumonia and improved Children with bronchoalveolar lavage fluid for bronchoscopy were used as the research object.The medical history,clinical symptoms,signs and various examination results of the research subjects were collected,and SPSS22.0 statistical software was used for analysis,and the clinical characteristics of the pathogenic distribution of children with refractory pneumonia were summarized.results:1.In this study,there were 295 cases that met the inclusion criteria,including 176(59.7%)male children and 119(40.3%)female children.The ratio of male to female was1.48:1.The minimum age of the study subjects was 29 days,the oldest was 13 years old,139cases(47.1%)were 28 days-1 years old,74cases(25.1%)were 1-3 years old,53cases(18.0%)were 3-7 years old,and 29 Cases were >7 years old(9.8%).29.2%(86/295)of the children had underlying diseases,of which cardiovascular diseases were the most common(45/295,15.3%),followed by respiratory diseases(24/295,8.1%),and a few cases had multiple primary diseases.2.Body temperature changes of 239 cases were recorded in detail in this study,of which197 cases(82.4%)had a fever during the course of the disease,with a heat peak of 42.0°C,a minimum of 37.6°C,and an average heat peak of(39.46±0.78°C).Among them,113 cases(57.4%)had a heat peak of 39.1℃-40℃.The shortest heat course was 1 day and the longest was 40.5 days.The average heat course was(7.56±5.98)days.3.The positive rate of pathogen detection by BALF gene chip method in 283 children was 85.9%(243/283),and a total of 518 pathogens were detected;the top three pathogens were MP(20.3%),RSV(12.4%)and PFLU(12.2%).The common pathogen in infancy is MP,the common pathogen in early childhood is RSV,and the common pathogen in preschool and school age is MP.A single pathogen was detected in 77 cases(31.7%),two pathogens were detected in 56 cases(23.0%),and three or more pathogens were detected in110 cases(45.3%).4.In this study,CRP(152/295,53.6%),ferritin(136/258,52.7%),IL-6(164/237,69.2%)increased,and some white blood cells(113/295,38.3 %),PCT(30/123,24.4%)increased.The vast majority of lung imaging examinations suggest inflammatory changes,of which consolidation and atelectasis are the most common(118/279,42.3%),followed by pleural thickening,and some are refractory Complications occurred in children with pneumonia(130/295,44.1%),and pleural effusion was the most common(47/295,15.9%).conclusions:1.The prevalence of refractory pneumonia in children decreases with the growth of the age.The most common is in infancy.Most of them have fever.Half of the cases has a heat peak temperature between 39.1℃-40℃,and the fever course is mostly within 7 days.Most of children with refractory pneumonia have elevated inflammation indicators.2.The three most common pathogens of refractory pneumonia in children are MP,PFLU,RSV,t the common pathogen in early childhood is RSV,the common pathogen in infancy、preschool and school age is MP,and Most are mixed infections.3.Children with refractory pneumonia are often accompanied by lung imaging changes,which are more common in lung consolidation and atelectasis.Some children have complications inside and outside the lung,and pleural effusion is the most common.