| Objective(1)To investigate the clinical characteristics of children with pulmonary necrosis in lobar pneumonia(hereinafter referred to as pulmonary necrosis),and to provide objective evidence for the diagnosis and treatment ofpulmonary necrosis.(2)To explore the significance of blood coagulation function,blood routine test,C-reactive protion(CRP)and lactate dehydrogenase(LDH)in the diagnosis of pulmonary necrosis and to providelaboratory basis forapplication of anticoagulant therapy in children with pulmonary necrosis.MethodsThe study is divided into two parts:The first part: A retrospective study of lungnecrosis among children hospitalized at theThirdAffiliatedHospitalof ZhengzhouUniversity from January 2005 to May 2016 was conducted.A total of 141 pulmonary necrosis cases were identified.Their age,sex,etiology,time oflung necrosis occurred,treatment methods and other clinical data were analised and descriped via statistics.The second part: Thirty-five children with lung necrosis that hospitalized at the Third Affiliated Hospital of Zhengzhou University from January 2013 to May 2016 were selected as the lung necrosis group.In the same hospital and same period,30 cases of lobar pneumonia with pleural effusion(hereinafter referred to as pleural effusion group)and30 cases of lobar pneumonia without pleural effusion(hereinafter referred to as lobar pneumonia group)were selected as the control group.The three groups were analyzed retrospectively and the clinical data of age,time oflung necrosis occurred,coagulation function,blood routine test,CRP and LDH were Compared between the three groups.All the statistical data were analyzed by SPSS17.0 software,with ?=0.05 as the test level.Results1.Clinical features of children with pulmonary necrosis(1)The general situation: 141 cases of pulmonary necrosis were admitted in this study,including 75 males(53%)and 66 females(47%).The maximum age was 144 months,the youngest age was 0.5 months.The average age of onset was 34.23 ± 34.90 months.The average days that chest imaging or surgery found lung necrosis was 18.59 ± 11.48 days after the disease onste.Between the male and fenale,There was no difference in the age of onset(P=0.644),but the days of lung necrosis occurred was different significantly(P=0.007).The days of lung necrosis occurred was 21.03 ± 12.90 days in the male patients,but 15.82 ± 8.92 daysin the female patients.(2)Etiology: Pathogenic microorganism of the 141 cases were grouped and analysed based on years.The primary pathogens causing lung necrosis from January 2005 to December 2007 was Pseudomonas aeruginosa,from January 2008 to December 2010 were Pseudomonas aeruginosa and Mycoplasma pneumoniae,from January 2011 to December 2013 were Staphylococcus aureus,from January 2014 to May 2016 were Mycoplasma pneumoniae,Streptococcus pneumoniae and Staphylococcus aureus.(3)Location of Pulmonary necrosis occurred: 75 cases occurred on the right side(53%),57 cases occurred on the left side(40%),and 9 cases occurred in bilateral(7%).(4)The discovery of lung necrosis:104(73.8%)cases of the 141 were diagnosed by chest Computed Tomography(CT).The remaining 37(26.2%)cases were not found cavities in the chest CT,and they were diagnosed when pulmonary necrosis were found in pleural decortication surgery.Several cases of the 37 were described as shadow of bronchi in lung tissue or pulmonary atelectasis in the reports of thoracic CT scans.(5)Treatment: There were 80 children with lung necrosis fromJanuary 2005 to December 2011.72 cases(90%)underwent surgical treatment;8 patients(10%)improved and discharged via medical treatment.From January 2012 to December 2014,there were 37 children with lung necrosis.28 cases(75.7%)underwent surgical treatment;9 patients(24.3%)improved and discharged via medical treatment.From January 2015 to May 2016,there were 24 children with lung necrosis.11 cases(45.8%)underwent surgical treatment;13 patients(54.2%)improved and discharged via medical treatment.A total of 61 cases of pulmonary necrosis were identified from January 2012 to May 2016.In the 61 children with pulmonary necrosis,22 cases underwent bronchoalveolar lavageand 39 cases not underwent bronchoalveolar lavage.The 61 patients were divided into two groups based on whether underwent bronchoalveolar lavage or not,and we found the treatment of bronchoalveolar lavagecan reduce the risk of surgery in children with pulmonary necrosis(P=0.024).2.Meaningful indicators on suggesting lung necrosis and the significance of the change of DDThe age of lung necrosis group was less than that of the two control groups(P<0.05).The levels of plasma fibrinogen(FDP),D-dimer(DD),white blood cell count(WBC)and platelet count(PLT)were higher than those in the control group(P<0.05).In the two control groups(P<0.05),LDH was lower than that in the pleural effusion group(P<0.05).Themultiplelogisticregressionanalysisshowed that age less than 36.6months,courseof disease more than 17 days,WBC more than 11.65×109/L,DD more than 3.65mg/Lwere risk factors of lung necrosis.Anticoagulant therapy can be given when DD are more than 3.65mg/L.Conclusion(1)This study shows that: lung necrosis occur mainly in children less than 3 years old,at the course of about 18 days after the disease onset.There is no difference between male and femalein the age of onset.(2)Pathogens of pulmonary necrosis were mainly Streptococcus pneumoniae,Staphylococcus aureus,Pseudomonas aeruginosa,Mycoplasma pneumoniae,etc.The main pathogens were different in different years.In recent years,Mycoplasma pneumoniae was the main pathogen of lung necrosis.(3)The treatment of bronchoalveolar lavage can reduce the risk of surgery in children with pulmonary necrosis.(4)As a childwithin 3-year-old catch lobar pneumonia,when the course of disease are more than 17 days,and the WBC are more than 11.65×109/L,and the DD are more than 3.65mg/L,the probability of pulmonary necrosis is large.Anticoagulant therapy can be given when DD are more than 3.65mg/L. |
PDF Full Text Request