Clinical Analysis Of407Cases With Lobar Pneumonia Of Children

Objective:Summarize the children with lobar pneumonia in recent years hospitallization dataincluding epidemiological characteristics, clinical characteristics, etiology and treatmentoutcome, to improve clinical doctors’ perception for early diagnosis, guide the rational use ofdrugs, shorten the duration of symptoms, and to offer reference to improve prognosis andreduce the complications.Methods:Collect the children hospitalization data who were diagnosed and treated as lobarpneumonia from January2010to December2012in jilin university first hospital ofpediatrics ward for statistical analysis, including the general situation, clinical symptoms andsigns, laboratory examination and radiographic changes, complications, treatment, andoutcome data.All data using SPSS17.0statistical software for statistical analysis.Result:1. Epidemiological characteristics：There were407children who were diagnosed andtreated as lobar pneumonia in our pediatrics ward during the year2010-2012, accounting for10.52%among the number of children with pneumonia in the same period,while constituentratio increased year by year, compared with2010,2011;In the data of407cases of lobarpneumonia in children, there were235male cases,172female cases,while the prevalence ofboys was higher than the girls; In this group, the youngest patient was25days, while theoldest14-year-old,the constituent ratio of7-14years old group was much higher than theother groups, the difference was statiscally significant (P <0.05);The seasonal distribution oflobar pneumonia in children was different in different months, the constituent ratio of winterand spring was significantly higher than the other seasons (P<0.05);Before admission, theshortest course was1day, and the longest course was60days with an average of9.88days,the highest constituent ratio of the duration before admission was between7days to2weeks, which was53.07%.2. The common symptoms are fever, cough. Of all the cases,396children had a fever of different degree (97.30%). The pattern of is irregular, majority ofpatiens had a high degree fever (58.97%) and most children had different extent cough (97.05%), for more irritating cough (58.48%), followed by coughing up phlegm, mostlywhite phlegm. In our data, there was1case with rusty sputum. The early Pulmonary physicalsigns were not obvious in the eary period while about55.28%of patients appearedpulmonary dry and wet rales in the late course of the disease, In some patients (12.78%),there was not any rales in the whole course of the disease. In different age phase, clinicalsymptoms and signs also had differences. Older children still presented with fever, cough asthe main manifestation, with some accompany symptoms such as sore throat, chest tightness,chest pain.While infant in the early course of disease could only showed short-of-breath,dyspnea, fever. Cough could occur in3-5days after the onset; Older children ususllysuffered with weak breathing of the diease side, and with the aggravation of the disease,this character became much more obvious, but rare in infant,Who give priority to breathsounds basic symmetric on both sides.3. Complications of respiratory system disease werethe most common (75.81%), of which the pleural effusion was the most common (46.31%).Also found that the cases of lobar pneumonia with mycoplasma infection were most likely tohave extrapulmonary complications.127cases (45.04%) of282cases with mycoplasmainfection had extrapulmonary organ damage.4. Imaging examination: In this group of dataunilateral lesions (75.18%) were much more than bilateral lesions (24.82%); lesions in rightside (47.67%) were more than that in left side(27.52%), and lower sides were the mostcommon.5. In the etiology examination of407cases, the positive rate is89.93%.58cases(14.25%) with pure bacteria infection,19cases(4.67%) with pure virus infection, and7cases (1.72%),with mixed bacteria infection and virus infection, a total of282cases (69.29%)with mycoplasma infection. In fluid cultures,123cases were positive, and the positive rateof BAL fluid and sputum was much higher than that in effusion culture and blood culture,while the positive rate for he effusion culture was higher that the blood culture, thedifference had statistically significant. Gram-positive were dominant which accounted forabout52.85%of the total strain. The top three of bacterial strains were streptococcuspneumoniae, staphylococcus aureus, klebsiella pneumoniae respectively. The mainpathogen of the virus infection was respiratory syncytial virus which accounted for27.03%.The other viruses followed by adenovirus, parainfluenza virus, influenza virus,cytomegalovirus, epstein-barr virus, coxsackie virus, herpes simplex virus. Pathogen isdifferent in different age stages.The pathogen of children below3years old was mostly purebacterial infection, while in the4~6age group and the7~14age group, the most commonpathogen was mostly mycoplasma infection.6. The WBC in209cases (51.35%) were normal, which were (4~10)×109/L,186cases were higher (45.70%) that was WBC>10×109/L and WBC of12cases was low (2.95%), WBC<4×109/L.7. The number of cases withCRP≧3mg/L, was a total of324cases (79.61%).8.282cases were mycoplasmapneumoniae antibody positive, the positive rate was69.29%.The positive rate ofmycoplasma pneumoniae antibody detection was different in different age groups. Themycoplasma antibody positive rate of0-3age group was obviously lower than that in4-6age group and7-14age group (P<0.05), however, there was no significantly differencebetween4-6age group and7-14age group.9.208cases with lobar pneumonia receivedBAL on the base of conventional treatment, the treatment effect is remarkable.The healingtime of fever and cough and the disappearance time of pulmonary rales were significantlyless than the conventional treatment group.In a summary, the conclusion is:1. The constituent rate of children lobar pneumonia is increasing year by year.2. Winter and spring is the highest-incidence period for lobar pneumonia in children.3.7-14years of age is the highest-incidence age for lobar pneumonia in children.4. Older children still present with irritating cough or coughing up white phlegm as themain manifestation,while infant can only show short-of-breath, dyspnea.5. The mycoplasma is the main pathogen of lobar pneumonia.6. On the basis of conventional therapy plus fiberbronchoscope lavage treatment canrelieve the inflammatory symptoms, shorten the course of disease.