| Objection:This study compared and analyzed the clinical data of children with lobar pneumonia treated by bronchoscopy combining with conventional medical treatment and conventional medical treatment alone through a large retrospective cohort study.The aim was to explore the therapeutic effect of bronchoscopy on children with lobar pneumonia.Methods:1.Identification of study subjects and collection of clinical data: This study took inpatients diagnosed with lobar pneumonia in the Department of Pediatric Respiratory Medicine in the Bethune First Hospital of Jilin University between December 2016 and December 2021 as the target population and a total of 630 children were enrolled in the study after screening based on specific criteria.The study collected general information such as age,gender,laboratory tests,etiological examinations,imaging tests,bronchoscopy results,hospitalization duration,costs and so on.The baseline clinical data,laboratory indicators,and etiological results of 630 children with lobar pneumonia were statistically described and analyzed using SPSS 26.0 software.2.Comparative analysis of baseline clinical indicators and etiological results after grouping: In terms of whether bronchoscopy was performed within four days of admission or not,630 children diagnosed with lobar pneumonia were divided into two groups: the bronchoscopy group and the medical treatment group.The SPSS 26.0statistical analysis software was used to comparative analyze the index,such as age,sex,days before admission,laboratory indicators within 24 hours of admission(WBC,NLR,PLR,CRP,D-D,LDH),baseline pneumonia volume ratio,and the presence ratio of complications between the two groups.3.Analysis of the baseline index and outcome indicators after the propensity scores matching: This study used the propensity score matching method to balance the severity of the children with lobar pneumonia in two groups,and got the balanced and comparable baseline clinical indicators between the two groups.After matching,these indexes such as age,sex,days before admission,laboratory indicators within 24 hours of admission(WBC,NLR,PLR,CRP,D-D,LDH),baseline pneumonia volume ratio,the presence ratio of complications and indicators after 5-7 days of treatment(WBC,NLR,PLR,CRP,D-D,LDH),hospitalization duration,costs,fever regression time,disappearance time of pulmonary signs,radiographic pneumonia volume improvement rate 1 month after discharge in two groups were statistically analyzed.4.After a natural grouping,these index of the children with lobar pneumonia in two groups were statistically analyzed,such as indicators after 5-7 days of treatment(WBC,NLR,PLR,CRP,D-D,LDH),hospitalization duration,costs,duration of fever,duration of positive pulmonary signs,imaging improvement rate of pneumonia volume1 month after discharge.5.Others: The results of bronchoscopic findings and alveolar lavage fluid-related etiological examination of children with lobar pneumonia in the bronchoscopy group were statistically described and analyzed.Results:1.A total of 630 children with lobar pneumonia was included in this study with an average age of 5.44±3.10 years,311(49.4%)cases were male children and 319(50.6%)cases were female children.In the baseline indicators,the median days before admission was 7(6,10)days,the median ratio of pneumonia volume at admission was0.060(0.032,0.104).There were 408(64.8%)cases without complications while 222(35.2%)cases with complications.There was no statistically difference in WBC between before and after treatment(P>0.05),and post-treatment indicators(NLR、PLR、CRP、D-D、LDH)were significantly lower than that before treatment(P<0.05).The median improvement rate in pneumonia volume after 1 month of discharge was 0.066(0.038,0.105),the median days of fever duration was 3(2,5)days,the median days of positive pulmonary signs duration was 9(5 to 11)days,the median total hospitalization cost was 12,954.04(8,112.46,19,180.69)Chinese yuan.About the etiological test results,231(36.7%)cases were negative and 399(63.3%)cases were positive.2.In this study,the 630 children diagnosed with lobar pneumonia were divided into two groups based on whether bronchoscopy was performed within four days of admission or not: 414 cases in the bronchoscopy group and 216 cases in the medical treatment group.There was no statistically difference in the sex of the two groups(P>0.05),and the difference in age was statistically significant(P<0.05).There were statistically significant differences in the days before admission,laboratory indicators within 24 hours of admission(NLR,PLR,CRP,D-D,LDH),the presence ratio of complications and the volume ratio of baseline pneumonia(P<0.05).In terms of etiology,114(52.8%)cases were positive in the medical treatment group while 285(31.2%)cases were negative in the bronchoscopy group.3.After the propensity score matching,in the medical treatment group and bronchoscopy group,190 children with lobar pneumonia were enrolled in each group.There were no significant differences in baseline indicators(age,sex,days before admission,presence ratio of complications,laboratory indicators within 24 hours of admission and baseline pneumonia volume ratio)between the two groups(P>0.05).In terms of outcomes comparison,the median improvement rate of pneumonia volume 1month after discharge in bronchoscopy group was higher than medical treatment group,the difference between the two groups was statistically significant(P<0.05).In other outcomes,there were no statistically significant differences in the hospitalization duration,duration of fever,duration of positive pulmonary signs and indicators after 5-7 days of treatment(CRP,D-D,LDH)(P>0.05).Indicator after 5-7 days of treatment(WBC)in bronchoscopy group was lower than that in the medical treatment group,the difference was statistically significant(P<0.05),and post-treatment indicators(NLR、PLR)were lower than those of bronchoscopy group,the difference was statistically significant(P<0.05).The hospitalization cost was higher in the bronchoscopy group than in the medical treatment group,and the difference was statistically significant(P<0.05).4.Before matching,as the primary outcome,the median improvement rate of pneumonia volume 1 month after discharge in bronchoscopy group was higher than that of medical treatment group,the difference between the two groups was statistically significant(P<0.05).Other outcomes such as hospitalization duration,hospital cost,duration of positive pulmonary signs and indicators after 5-7 days of treatment(CRP,NLR,PLR,D-D,LDH)in bronchoscopy group were higher than those in the medical treatment group,the differences were statistically significant(P<0.05).And WBC in bronchoscopy group were lower than that in the medical treatment group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the duration of fever after treatment(P>0.05).5.Pathogen detection with bronchoalveolar lavage fluid combined with the conventional pathogen detection methods in the bronchoscopy group,311(75.1%)had positive results while 103(24.9%)cases were.The positive rate of routine pathogen detection combined with alveolar lavage fluid detection test was higher than that of conventional pathogen detection alone,and the difference was statistically significant(P<0.05).Besides,in the bronchoscopy group,the airway mucosa under bronchoscopy showed mucosal hyperemia and edema in 373 cases,mucus plugging/sputum plugging blockage in 134 cases,mucosal granular hyperplasia in 70 cases,mucosal longitudinal folds in 123 cases,bronchial stenosis in 65 cases,necrosis in 56 cases under the scope,10 cases of obliterating bronchitis and 6 cases of plastic bronchitis.Conclusion:1.Bronchoscopy can improve the positive detection rate of pathogens in children with lobar pneumonia with bronchoalveolar lavage fluid,which has advantages over conventional medical testing methods.2.Flexible bronchoscopy in the treatment of lobar pneumonia has a significant effect on airway clearance,reducing of inflammatory mediators and promotion of pulmonary ventilation recovery.3.Bronchoscopy on the basis of conventional medical treatment in children with lobar pneumonia has a solid role in promoting the recovery of the volume of pneumonia in a short time(1 month). |
PDF Full Text Request