The Clinical Analysis Of Necrotizing Pneumonia In 26 Childrens

Background: Community-acquired pneumonia is the most common infectious disease in childhood,which is the main causes of disease Death of children under 5 Years Old.Necrotizing pneumonia in children is a rare whereas severe complication of community-acquired pneumonia,result from both the infection of pathogenic microorganism and disorder immunity of body.It is characterized by parenchyma destruction,liquefaction necrosis and cavitation formation of lung tissue.Its morbidity is increasing With the development of imaging technology and the improvement of NP recognition of children Since the first reports of foreign scholars in the 1980 s.the main pathogeny is changing over time The clinical manifestation of necrotizing pneumonia is more serious and has faster progression of symptoms,more complications and longer hospitalization than ordinary pneumonia It is very important to improve prognosis in early diagnosis and timely treatment.Objective: Summarize the clinical data about 26 cases necrotizing pneumonia in our hospital to raise the level of diagnosis and treatment.Methods: Analysis retrospectively the clinical data of children with NP who were admitted to the Children's hospital affiliated to chongqing medical university from June 2013 to October 2017.Results: 26 pediatric patients with NP were enrolled,male: 16 cases,female: 16 cases,(male/female1.6);the median age: 2.5years old;14childrens under 3years old,12 childrens aged 3 and above;the average hospital stay(23.38 ± 11.20)d,the average febrile time(23.46 ±11.63)d;100% childrens had fever,92.3% childrens had cough;The maximum value of WBC from(9.02-48.49)×109/L,CRP from(8-256)mg/L,PCT from(0.01-100)ng/mL,ESR from(20-140)mm/1hr,92.3% patients D-Dimer rising,73.1% patients fibrinogen rising;84.6% childrens had positive results in etiology.the main pathogen was bacteria especially the streptococcus pneumoniae with the children under 3years old,wheras the mycoplasma pneumoniae was the main pathogen with the children aged 3and above;Necrotisiting could occur in both lungs,the probability of the left lung is greater especially the inferior lobe,100% patients had Pleural effusions,Bacterial infections wrer more likely to occur in a large number of pleural effusions;ALL childrens were treated with antibiotics,11 cases combined with glucocorticoid,7cases with IVIG,12 cases with bronchoalveolar lavage,12 cases with surgical treatment;ALL of childrens were released from the hospital.For most children,with imaging follow-up lung consolidation and liquefaction necrosis reduced,cavity disappeared pleural effusions absorbed in,a few children remain band-like scars,cystic degeneration or atelectasis.Conclusion: The pathogeny closely related to the age of children with NP,the main pathogen was bacteria especially the streptococcus pneumoniae with the children under 3years old,wheras the mycoplasma pneumoniae was the main pathogen with the children aged 3 and above;For children with lobular pneumonia,When keep fever over 3weeks,inflammatory index D-Dimer and fibrinogen keep rising,with pleural effusion,the occurrence of NP should be alerted;Despite the clinical manifestation of necrotizing pneumonia is serious.It can be successfully treated with antibiotics combine GC,IVIG,and BAL.when occur empyema,pyopneumothorax,BRF,and large pleural effusion,combine surgical treatment Finally the prognosis is relatively well for most children.