| Objective:Clinical data of children with necrotizing pneumonia(NP)were analyzed to investigate the clinical characteristics and risk factors of surgical treatment of NP in children.Methods:Retrospective analysis of studies.A total of 119 children with NP admitted to XXX Hospital from January 2017 to June 2022 were selected.According to whether they underwent surgery,they were divided into surgical treatment group(68 cases)and conservative treatment group(51cases).The clinical data of the two groups were collected,including gender,age,clinical manifestations,preoperative laboratory examination(white blood cell count and classification,procalcitonin,high-sensitivity C-reactive protein,serum protein content),imaging manifestations(lung consolidation range,pleural effusion volume,cavity liquefaction range),treatment plan,hospitalization time,hospitalization cost,and postoperative complications symptoms and disease outcomes.SPSS25.0 statistical software was used to analyze the data.Measurement data were compared by independent sample t test or Mann-Whitney U test.Counting data were compared using Chi-square test or Fisher’s exact probability method.There were statistically significant differences between the two groups,and Logistic regression analysis was performed to explore the factors for surgical treatment in children with NP.Results:1.General data:There were 68 patients in the surgical treatment group included 42(61.76%)males and 26(38.24%)females,with a median age of 2.50(1.37,4.71)years.In the conservative treatment group,there were 51 cases,including 31 males(60.78%)and 20 females(39.22%),with a median age of 4.58(1.50,7.33)years.Compared with the two groups,the age of the operation group was younger(Z=-2.119,P=0.034).There was no significant difference in sex composition ratio(P>0.05).2.Clinical manifestations and complications:compared with conservative treatment group,the thermal course of children in surgical treatment group was prolonged[12.5(7.0,17.3)days VS 9.0(5.0,13.0)days](Z=-2.476,P=0.013);There were no significant differences in the incidence of cough,expectoration,shortness of breath,dyspnea,chest pain and shock(P>0.05).In terms of complications,the number of patients with sepsis in surgical combination was higher than that in conservative treatment group[45(66.18%)cases VS 18(35.29%)cases](~2=11.156,P=0.001).There was no significant difference in the combined rates of encephalitis and osteomyelitis(P>0.05).3.Laboratory examination:Comparing the two groups,leukocyte count[14.68(11.45,22.31)*10^9/L VS 10.70(8.12,15.72)*10^9/L],neutrophil count[9.26(4.66,14.95)*10^9/L VS 6.57(3.54,10.18)*10^9/L],the level of hypersensitive C-reactive protein[100.04(33.82,169.64)mg/L VS 26.68(7.32,101.25)mg/L],the incidence of hypoproteinemia[22(32.35%)cases VS 10(19.61%)cases],The surgical treatment group was higher than the conservative treatment group,with statistical significance(P<0.05).4.Physical examination of pathogen:39(57.35%)strains were detected in the surgical treatment group and 35(68.63%)in the conservative treatment group.Compared with the two groups,the detection rate of Streptococcus pneumoniae in the surgical treatment group was higher than that in the conservative treatment group[8(11.76%)strains VS 0 strains](~2=9.384,P=0.001).5.Imaging findings:Comparing the two groups,the number of more than 2 cases of pulmonary consolidation[38(55.88%)VS 18(35.29%)cases],the number of multiple liquefaction cavities[58(85.29%)VS 31(60.78%)cases],the number of patients with moderate pleural effusion[6(8.82%)VS 0 cases]and the number of patients with large pleural effusion[25(36.76%)VS 4(7.84%)cases]were higher in the surgical treatment group than in the conservative treatment group,with statistical significance(P<0.05).6.Treatment:Among the 68 children treated with surgery,antibiotics were used for 11(7,15)days before surgery.After conservative treatment,63(92.65%)patients had no obvious absorption of the original lesion,and even showed aggravation.26(38.24%)patients still had sepsis.There were 54(79.41%)cases were wedged resection of lung,10(14.71%)cases were pleural exfoliation,and 4(5.88%)cases were lobectomy.Compared with the conservative treatment group,the cases of human blood albumin,human immunoglobulin,thoracic drainage,blood transfusion and mechanical ventilation were significantly increased,with statistical significance(P<0.05).7.Postoperative complications,length of stay,cost of stay and prognosis:Postoperative complications occurred in 38 children in the surgical treatment group,accounting for 55.88%,among which fever,pneumothorax,hypotension,BPF and incision infection were 34(50%)cases,10 cases,4cases and 1 case each,respectively.The median fever time was 2.0(1.8,3.0)days.The surgical treatment group needed longer hospitalization time and higher hospitalization cost,and the differences were statistically significant(P<0.05).After treatment,all the children in the surgical treatment group were discharged from hospital.Among the children treated conservatively,50(98.04%)patients were discharged from hospital with improvement,and 1(1.96%)patients died,with no statistical significance(P>0.05).8.Predictive factors of surgical treatment in children with NP:Multivariate logistic regression analysis and ROC curve plotting showed that heat duration>13.5 days,combined with sepsis and moderate to massive pleural effusion were risk factor for surgical treatment of children with NP.Conclusions:1.Compared with the children treated conservatively,the children treated with surgery was younger,the detection rate of streptococcus pneumoniae was higher,the inflammatory index was increased more significantly,and the combination of sepsis and hypoproteinemia was more common;2.Children treated with surgery need higher nutritional and immune support,which increases the risk of blood transfusion,long thoracic drainage and postoperative complications,cost and length of hospitalization increased significantly.Therefore,while actively treating children,excessive treatment should be avoided and surgical adaptation should be strictly controlled.3.Sepsis combined with moderate-large pleural effusion and persistent fever for more than13.5 days as suggested by lung imaging are risk factors for surgical treatment in children with NP. |
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