Application Value Of Bronchoscope In Acute Phase Of Severe Adenovirus Pneumonia In Children

Objective:To explore the safety of soft bronchoscopy（referred to as bronchoscopy）in the acute stage of severe adenovirus pneumonia in children and its impact on the prognosis.Methods:To analyze the clinical data of children with severe adenovirus pneumonia who were admitted to the Children’s Intensive Care Unit（PICU）of Hunan Provincial People’s Hospital from October 1,2018 to September 30,2019.According to whether bronchoscopy treatment is performed in the acute phase,the bronchoscopy treatment group（study group）and the conventional treatment group（control group）were matched in a 1:2 ratio according to age,disease course,and Pediatric critical illness score（PCIS）.According to the acute course of the disease,they were divided into two subgroups:disease course≤7 days and>7days.1.Compare the general information and prognostic indicators of the study group and the control group.2.Compare the oxygenation index（P/F）,partial pressure of carbon dioxide（PCO2）,PCIS before and after bronchoscopy in the study group.3.Compare the dynamic changes of P/F,PCO₂,PCIS in the heat course between the study group and the control group.Results:This study investigated a total of 177 cases of severe adenovirus pneumonia,including 159 children with severe adenovirus pneumonia that met the selection criteria,of which 43 were treated with bronchoscopy and 116 were treated with conventional treatment.According to age,disease course,and PCIS,37 cases were included in the study group and 74 cases were included in the control group.1.Comparison between the study group and the control group:Lactate dehydrogenase（LDH）in the control group was significantly higher than that in the study group（Z=-2.44,P=0.015）.There were no statistical differences in other general information on admission,fever time,hospital stays,intensive care time,invasive mechanical ventilation ratio and time,Acute respiratory distress syndrome（ARDS）incidence,Bronchiolitis obliterans（BO）incidence and mortality rate between the two groups.2.Changes of P/F ratio,PCO₂ and PCIS before and after bronchoscopy in the study group:The PCIS score and P/F ratio of the study subgroup of disease course≤7 days on day 1,day 3,day 5,and day 7 after treatment were significantly lower than before treatment（P<0.05）,but no progressive decline;and PCO₂ was higher than before treatment（P<0.05）,but there was no progressive increase and they were all within the normal range.The PCIS score and P/F ratio of the study subgroup of disease course>7 days,on the first day after bronchoscopy treatment were lower than those before treatment,and there was no significant difference between the third day before and after treatment,and there was no significant change in PCO₂ before and after treatment.3.Comparison of changes in P/F ratio,PCO₂ and PCIS in the heat cycle between the study group and the control group:On the 9th to 12th days of the disease course,the PCIS score of the children in the study group was lower than that of the control group for the disease course≤7 days,but there was no significant difference in the P/F ratio between the two groups.There was no significant difference in P/F ratio and PCO2between the study group and the control group for the course of disease>7 days,the PCIS score of the study group was lower than the control group on the 9th day of the disease course（P=0.008）.There was no significant difference in PCIS score between the two groups during the rest of the disease.Conclusions:Bronchoscopy treatment in children with severe adenovirus pneumonia in the acute stage may aggravate the children’s condition in the short term,especially in the first week of the disease course,but it will not affect the overall prognosis of the children.