| Objective:To explore the clinical efficacy of inhalation of acetylcysteine solution by retention perfusion therapy,comparing the treatment of severe pneumonia with inhalation of acetylcysteine solution,in children,under electronic bronchoscopy and normal saline alveolar lavage.Method:192 children,A retrospective analysis conducted with SP,retrospectively,admitted to the Department of Pediatrics of Ganzhou People’s Hospital from May2021 to September 2022.A total of 89 patients,according to the inclusion and exclusion criteria,ultimately,met the inclusion criteria were included in our study,divided into a control group(n=43)and a experimental group(n=46),whether the acetylcysteine solution for inhalation was retained under bronchoscopy.The control group treated with normal saline alveolar lavage under electronic bronchoscopy,while the research group with acetylcysteine solution for local retention perfusion after normal saline alveolar lavage under electronic bronchoscopy.The inflammatory indicators,after a week treatment,observed and statistically analyzed the curative effects:procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),white blood cells(WBC),interleukin-6(IL-6),and pulmonary CT imaging changes,And the duration of fever after treatment Cough duration,lung rale duration,hospital stay,incidence of adverse reactions,with Comparing during treatment.Results:(1)There were 26 cases(29.2%)aged<3 years old,44 cases(49.4%)aged 3-6years old,and 19 cases(21.3%)aged>6 years old,suggesting that 3-6 years old was the age of high incidence of SP.(2)In this study,64 children were detected for pathogens with a positive rate of71.9%.There were 42 cases of single pathogen infection,and 22 cases of mixed infection.A total of 91 pathogens were detected,including 36 bacteria strains(39.6%),28 viruses(30.8%),25 atypical pathogens(27.5%),and 2 fungi strains(2.2%).Bacteria are the main pathogen of SP in children,and the highest detection rate of bacteria was streptococcus pneumoniae(11 strains,12.1%).Then,the highest detection rate of viruses was adenoviruses(9 strains,9.9%).Mycoplasma pneumoniae has been the main atypical pathogen(21 strains,23.1%).(3)At the time of admission,87 cases(97.8%)among the 89 children with SP had exudative changes evidenced by CT examination of lung organ whereas 2 cases(2.2%)had no exudative changes with only thickened markings in lungs.Among them,62 cases(69.7%)had bilateral lung lesions,and 25 cases(28.1%)had unilateral lung lesions including 16 cases(18%)with right lung lesions only,and 9 cases(10.1%)with left lung lesions only.These suggest that bilateral lung infections are common in children with SP whereas unilateral lesions mainly in the right lung of children.(4)After treatment,the levels of various inflammatory factors in the experimental group and the control group were lower than those before treatment.In the control group,they were listed as PCT(1.57±0.62ng/ml before treatment and0.83±0.32 ng/ml after treatment),hs-CRP(30.15±16.52 mg/L before treatment and17.25±10.52 mg/L after treatment),WBC(16.48±3.78×10~9/L before treatment and5.07±3.78×10~9/L after treatment),IL-6(60.44±8.14 pg/m L before treatment and34.56±15.14 pg/m L after treatment).In the experimental group:they were expressed as PCT(1.48±0.76 before treatment and 0.92±0.41 ng/m L after treatment),hs-CRP(31.11±17.88 mg/L before treatment and 19.73±6.88 mg/L after treatment),WBC(17.75±3.30×10~9/L before treatment and 7.75±4.39×10~9/L after treatment),IL-6(61.81±7.97 pg/m L before treatment and 37.83±9.97 pg/m L after treatment).The difference of various inflammatory factor indexes between the control group and the study group before and after treatment was statistically significant(P<0.05).The independent sample t-test analysis showed that the decreases of various inflammatory factor indexes between the experimental group and the control group after treatment were statistically significant(P<0.05).(5)After one week of treatment,the experimental group showed more absorption of inflammation compared with the control group evidenced by CT examination(P<0.05).The experimental group improved better lasting time of fever,cough,lung rale,and hospital stay compared with the control group.The independent sample t-test analysis showed that the differences between the experimental group and the control group after treatment were statistically significant(P<0.05).(6)According to comprehensive evaluation,after one week of treatment,10children in the control group reached the super effective standard(23.26%),26children(60.47%)reached the normal effective standard,and the total effective rate achieved 83.72%.In the experimental group,21 patients(45.65%)met the super effective standard,23 patients(50.00%)met the normal effective standard,and the total effective rate was 95.65%.Theχ2 test analysis showed that the treatment effects of the experimental group were significantly improved compared with the control group(P<0.05).(7)Electronic bronchoscopy-mediated alveolar acetylcysteine administration had a low incidence of complications in children with SP.Among 89 patients,5 cases(5.62%)had adverse reactions.The incidence of complications in the experimental group was 4.35%(2 patients)while that in the control group was 6.98%(3 patients).There was no significant difference in the incidence of complications between the experimental group and the control group(P>0.05).Conclusion:(1)Electronic bronchoscopy-mediated inhalation of acetylcysteine solution to SP children could reduce lung inflammation indicated by the levels of WBC,hs-CRP,PCT,and IL-6 resulting in improvement of clinical efficacy.(2)Electronic bronchoscopy-mediated retention perfusion of acetylcysteine solution could effectively improve clinical symptoms and lung characteristics,promote absorption of lung lesions,facilitate the recovery of disease leading to effectively shorten the course of disease.(3)Fiberoptic bronchoscopy-mediated retention perfusion of acetylcysteine solution could be a safe strategy to improve severe pneumonia of children with less complications. |
PDF Full Text Request