Study On The Clinical Characteristics Of Refractory Mycoplasma Pneumoniae Pneumonia And The Timing Of Pulmonary Interventional Therapy

Objective: To observe the clinical symptoms,pathogens,laboratory tests,imaging,and bronchoscopy changes of refractory mycoplasma pneumoniae pneumonia(RMPP),and to explore the effects of different time of bronchoalveolar lavage on acute symptoms and prognosis imaging.Provide a theoretical basis for the clinical choice of interventional therapy opportunities.Method: A retrospective analysis was performed to select patients admitted to the Department of Respiratory Medicine at the Dalian Children's Hospital from September 2017 to December 2018,who were diagnosed with refractory mycoplasma pneumoniae pneumonia and who underwent bronchoalveolar lavage during hospitalization.102 cases were observed for clinical symptoms,internal and external complications,pathogens,auxiliary examination,bronchoscopy,and the first time for treatment of bronchoalveolar lavage according to the course of disease: early intervention group,mid-intervention group,late intervention group.The differences in fever duration,cough duration,discharge imaging,and 1-month post-discharge chest imaging,treatment outcome,and length of hospital stay were compared between the three groups.Result:1.Among the 102 patients with RMPP who met the inclusion criteria,the male to female ratio was 1.68:1,and the average age was 6.42±3.25 years.All children developed fever and cough symptoms,and 15.69% of the children developed wheezing.The fever,cough,and wheezing duration were respectively 14.33±5.85 days,25.58±10.13 days and 5.63±3.96 days.2.102 cases of RMPP,pulmonary complications were the most common pleural effusion,accounting for 79.55%;extrapulmonary complications with digestive symptoms were the most common,accounting for 36.96%;chest imaging was most likely to involve the right lung,accounting for 48.04%;under bronchoscopy,mucosal congestion,edema,and discharge floating were the most common,accounting for98.04%.3.In 102 cases of RMPP,55 cases of other pathogens were detected,accounting for 53.92%.A total of 60 cases were detected: 39 cases of bacteria,accounting for65%;17 cases of virus,accounting for 28.33%;and 4 cases of fungi,accounting for6.67%.Bacterial infection is most common in Gram-positive cocci,accounting for82.05%.The most common virus infection was EB virus,accounting for 76.47%.4.Among 102 patients with RMPP,the fever,cough and hospitalization time in the early intervention group were 11.04±2.53 days,20.96±6.44 days,15.04±4.69 days respectively.The fever,cough and hospitalization time in the intermediate intervention group were 15.86±4.26 days,25.33±5.93 days,17.56±6.56 days respectively.The fever,cough and hospitalization time in the late intervention group were 20.06±8.85 days,38.39±13.71 days,19.17±5.98 days respectively.The three groups were compared by analysis of variance,P < 0.05,which was statistically significant.5.Among the 102 patients with RMPP,the total effective rate of early intervention group was 85.42%;the total effective rate of the intermediate intervention group was 77.78%;the total effective rate of the late intervention group was 72.22%,and the three groups were compared by chi-square test,?2=1.687,P=0.430>0.05,the difference was not statistically significant.One month after discharge,the total effective rate was 95.83% in the early intervention group,94.44%in the intermediate intervention group,and 77.78% in the late intervention group.The chi-square test was performed in the three groups,?2=6.307,P=0.043<0.05,the difference was statistically significant.Conclusion:1.RMPP showed fever and cough symptoms,some children had wheezing.Pulmonary complications are most common in pleural effusion.Extrapulmonary complications are most common in digestive system complications.Chest imaging is easy to involve right lung.Bronchoscopic microscopic findings are most common with mucosal congestion,edema,and discharge.2.About 1/2 of RMPP combined with other pathogen infections,among which bacteria are most common,mainly Gram-positive cocci;followed by viruses,mainly Epstein-Barr virus.Mixed infection increases the clinical difficulty of RMPP.3.RMPP in the early and middle stages of the disease(21 days)bronchoalveolar lavage treatment can shorten the acute phase of the disease,significantly improve the imaging absorption of the recovery period,have a good clinical effect.It is recommended that children with RMPP undergo interventional therapy as soon as possible.