Clinical Study Of Severe Pneumonia In Children

Objective : To analyze the clinical,radiological,laboratory and etiological characteristics of children with severe pneumonia and the incidence of complications,to explore the therapeutic value of bronchoalveolar lavage for severe pneumonia in children,provide a theoretical basis for the clinical diagnosis and treatment of severe pneumonia in children.Method:Using retrospective analysis,select hospitalization in the respiratory department of Children's Hospital in Dalianl from January 1,2016 to December 31,2016 that meet the inclusion criteria,age <14 years old,exclude congenital respiratory diseases such as laryngeal,bronchial,lung and thoracic dysplasia or malformation,there are no organ-based diseases such as liver,kidney,heart,etc,without coagulation and abnormal immune function,clinical diagnosis of severe pneumonia in 64 patients,divided into two groups,15 patients in the conventional treatment group were given routine treatment such as anti-infection and symptomatic treatment,in the routine lavage group,49 patients had no improvement after the routine treatment such as anti-infection and symptomatic treatment,that is,the frequency of fever has not been reduced,and no peak fever has been seen,bronchoalveolar lavage was performed by bronchoscopy,the etiological distribution,clinical symptoms,imaging changes,enzymology,infection indicators,and complications were analyzed,the clinical symptoms and imaging changes in the two groups were observed and the efficacy of bronchoalveolar lavage in the treatment of severe pneumonia was analyzed.Results:1.Among the 64 children with severe pneumonia,the preschool age and preschool age were the highest,among which 3-6 years old accounted for 21.8% and6-13 years accounted for 59.3%.2.Children with severe pneumonia have cough and fever,and 17.2% of childrenwith severe pneumonia have wheezing symptoms.Pleurisy is highest in complications of severe pneumonia,accounting for 43.5%,in the lavage group,there were 29 cases with complications(59.2%),and the incidence of complications was higher than that of the conventional group,after chi-square test.P>0.05,the difference was not statistically significant.Children with severe pneumonia were mainly single lung involvement,accounting for 75%;unilateral lung involvement was mainly right,accounting for 65%,in the lavage group,11 cases of imaging showed bilateral pulmonary involvement,accounting for 22.4%,and the incidence of bilateral lung involvement was lower than that of the conventional group,after chi-square test,P>0.05,the difference was not statistically significant.Severe pneumonia in children with alanine aminotransferase,aspartate aminotransferase,creatine kinase and its isoenzymes have different degrees of involvement,the most creatine kinase,accounting for 18.8%;followed by aspartate aminotransferase,accounting for 15.6%;the lowest for alanine aminotransferase,accounting for 6.3%.The abnormal rate of C-reactive protein in children with severe pneumonia was 92.2%,and the abnormal rate of haemotropinogen was 73.5%,in the lavage group,47 cases were abnormal in blood C-reactive protein,accounting for 95.9%.The abnormal rate of blood C-reactive protein was higher than that in the conventional group,after chi-square test,P<0.05,the difference was statistically significant;in the lavage group,there were 37 cases of abnormal blood calcitonin,accounting for 75.5%,and the abnormal rate of blood calcitonin was higher than that of the conventional group,after chi-square test,P>0.05,the difference was not statistically significant.3.The detection rate of pathogens in children with severe pneumonia was 78.00%.Children with severe pneumonia had the highest incidence of single etiology,accounting for 68%.Children with severe pneumonia have the most infection with mycoplasma,accounting for 68%,followed by bacterial infections,accounting for22%,at least the virus infection,accounting for 10%.4.Forty-nine children underwent bronchoalveolar lavage on the basis of routine treatment,the postoperative temperature was 1.04±1.68 days.Sixty-four children with severe pneumonia were treated and their clinical symptoms were completely relievedfor 5 days,when the clinical standard reached the discharge standard,the imaging absorption area was observed,imaging area was more than 75%,and the routine group was 5 cases,accounting for 33.3%,lavage group,27 cases,accounting for55.1%;imaging absorption area> 50%,routine group 2 cases,accounting for 13.4%,lavage group,17 cases,accounting for 34.7%;lavage group imaging absorption area is higher than the conventional group,by the card The square test,P <0.05,the difference was significant and statistically significant.Among the 64 children who achieved clinical recovery,4 were in the conventional group,accounting for 26.7%,and 22 in the lavage group,accounting for 44.9%,the cure rate in the lavage group was higher than that in the conventional group,the difference was significant and statistically significant.Conclusions:1.In this group of children with severe pneumonia,older children are the predominant children.More than half of them are in school-age and one-fifth of them are in preschool age.2.About 1/6 of children with severe pneumonia have airway involvement;more than half of children with severe pneumonia have varying degrees of complications,pleurisy is its major complication,1/6-1/7 of severe pneumonia He had liver damage and myocardial injury,respectively;3/4 of the children with severe pneumonia involved a single lung,with the right lung involved.3.In children with severe pneumonia,two-thirds of the children were single-pathogen infected,with mainly mycoplasma pneumoniae infections;one-third of the children were mixed infections.In bacterial infections,there are mainly cocci infections.4.Patients with severe pneumonia who have poor conventional treatment and continue to develop severe illness,bronchoalveolar lavage can quickly relieve symptoms within 1-2 days,improve the clinical cure rate,with good clinical efficacy.