| Objective：Severe pneumonia in children occurs in an acute and grave manner and changesin a quick and complex manner, which is the leading cause of the death of childrenbelow5years old. Routine treatment methods have disadvantages including slowrecovery of clinical symptoms, indexes of laboratory examinations and shadowsfrom the imaging as well as low positive pathogen detection rates. Electronicbronchoscopyis a microbiological examination performed by collectingbronchoalveolar lavage fluid, which effectively improves the positive pathogendetection rate and provides a more accurate basis for rational clinical use ofantibiotics. Meanwhile, in such examination, the forms of tracheal and bronchialmucosas are directly observed to accurately grasp the condition includingbronchialdeformity, bronchial foreign bodies and blockage caused by bronchial secretions,and bronchoalveolar lavage can be performed in targeted diseased regions, therebyclearing away inflammatory secretions, removing lumen clogging, relieving localedema, shortening illness duration. This study was aimed at exploring the role ofelectronic bronchoscopy in the treatment of severe pneumonia in children, andproviding feasible treatments, thereby providing a scientific and rational theoreticalbasis for the future extensive application of electronic bronchoscopy in the treatmentof severe pneumonia in children.Methods：In this study, the data was collected from200sick children, who were admittedand confirmed to have severe pneumonia in children in the Department ofRespiratory Medicine of a tertiary hospital at grade A in Changchun, China, betweenFeb.2011and Dec.2014. The children were randomly divided into observation groupand control group, and each group was composed of100cases. All children’s condition was accompanied by symptoms including cough, persistent hightemperature, excessive phlegm and asthma. Most children’s nocturnal sleep was notpleasant. The observation group received electronic bronchoscopy and conventionalmethods, while the control group received treatment with conventional methods. Ananalysis was made to compare the two groups regarding their related indexes, suchas duration of fever, duration of cough, chest X-ray image, total WBC. An analysiswas made to compare the two groups regarding their related indexes, such aspathogens of bronchoavleolar lavage, In addition other analysis was made tocompare the two groups(electronic bronchoscopy group and chest X-ray imagegrpup) regarding their related indexes,bronchial deformity and bronchial foreignbodies, and meanwhile, an analysis was made for the changes of hear rates and bloodoxygen saturations in various durations in the observation group.Results：1.Basic data of both groupsThere were no statistical differences between both groups regarding their age andsex (P>0.05).2. Condition of the recovery of clinical symptoms in both groups①The results of analysis of the durations of fever showed that the medianduration was7days in the observation group, less than the median duration of8daysin the control group, and the difference was statistically significant(Z=-7.64,P<0.001).②The results of analysis of the durations of cough outcomeshowed that the median duration was9days in the observation group, less than themedian duration of10days in the control group, and the difference was statisticallysignificant (Z=-8.14, P<0.001).3. Comparison of thecondition of recovery showed by auxiliary examinationsbetween groups①The results of analysis of the condition of recovery showed by imagingshowed that during1week,1~2week, and2-4week of hospital stay, all the rates of recovery showed by imaging in the observation group were markedly higher thanthose in the control group (χ2=11.39656，P=0.003). Particularly, at point of1and1-2weeks during hospital stay, the proportion of recovery showed by imaging in theobservation group is more than control group.②The routine blood tests selectedfor both groups’ patients with elevated total WBC (exceeding10.0×109/L) showedthat at1week of hospital stay, the rate of recovery of total WBC in the observationgroup was60.00%(33/55), higher than that in the control group26.00%(12/46), andthe difference was statistically significant (χ2=12.64, P<0.01).4. Changes of SpO2and HR in sick children in the process of electronicbronchoscopyAll patients in the observation group received electronic bronchoscopy withinthree days after admission. In the process of treatment, i.e. when the bronchoscopepassed through the glottis and targeted regions as well as when the examination wasover, the HR (heart rate) in all patients had no marked changes compared with thatbefore examination(t=0.848,P=0.398;t=1.540,P=0.127;t=1.888,P=0.061), while theSpO2(oxygen saturation) in all patients had marked changes compared with thatbefore examination (Signed rank sum test: S=-1234.5, P<0.001; S=-829.5, P<0.001;S=1295.5, P<0.001). When the bronchoscope passed through the glottis and targetedregions, there was excessive hypoxia, however, when the examination was over, theSpO2recovered and rose than that before examination.5. Comparison of the pathogen detection rates of observation group in differentSpecimensIn the observation group, bronchoalveolar lavage fluid was used as a specimen,while in the control group, only throat swabs and venous blood specimens were used;then, pathogen detection was performed to analyze the infective agents of severepneumonia in both groups.①The rate of infection caused by Streptococcuspneumoniae in the bronchoavleolar lavage group was39.00%(39/100), higher thanthat22.00%(22/100) in the General specimens group, and the difference was statistically significant （X2=15.696，P<0.001）.②The detection rate of Mycoplasmapneumoniae in the bronchoavleolar lavage group was41.00%(41/100), higher than24.00%(24/100) in the General specimen group, and the difference was statisticallysignificant (X2=15.696，P<0.001).③The rates of infection caused by adenoviruses,Staphylococcus aureus and Pseudomonas aeruginosa in both groups were notmarkedly different(χ2=1.000，P=0.317；χ2=1.000，P=0.317；χ2=3.000，P=0.083).6. Comparison of the diagnosis rates of congenital bronchial deformity by usingdifferent methods in observation groupsComparison of the diagnosis rates of congenital bronchial deformity betweenboth groups was made according to electronic bronchoscopy for the electronicbronchoscopy group as well as according to chest X-ray imaging alone for thecontrol group. The results showed that the rate of congenital bronchial deformity inthe electronic bronchoscopy group was15.00%(15/100), higher than that5.00%(5/100) in the control group, and the difference was statistically significant(χ2=8.333,P=0.0039).7.Comparison of the detection rates of bronchial foreign bodies by usingdifferent methods in observation groupsComparison of the detection rates of bronchial foreign bodies between bothgroups was made according to electronic bronchoscopy for the electronicbronchoscopy group as well as according to chest X-ray imaging alone for thecontrol group. The results showed that the detection rates of foreign bodies in theelectronic bronchoscopy group was11.00%(11/100), while the one in the generalgroup was0.00%.Conclusion：1. Electronic bronchoscopy for severe pneumonia in children can shorten theduration of cough and fever.2. Electronic bronchoscopy for severe pneumonia in childrencan promote theabsorption of chest X-ray shadows and the recovery of total WBC in early course of disease(2week)3. Electronic bronchoscopy has a high sensitivity in the detection for the causesof severe pneumonia in children, including congenital bronchial deformity,Streptococcus pneumoniae and Mycoplasma pneumoniae as well as trachealforeign bodies.4. In the process of electronic bronchoscopy for severe pneumonia in children, ithas no effect upon the heart rate and can improve the oxygen saturation of sickchildren. |
PDF Full Text Request