| Objective:Analyze the etiology characteristics of children with severe pneumonia in the children's hospital affiliated to soochow university,studying the early clinical manifestations and laboratory examination characteristics of children,explore tihe related risk factors of severe pneumonia and poor prognosis?to provide basis and reference for early judgment,identification of high-risk children,timely treatment and improvement of prognosis in clinical work.Methods:1129 hospitalized children with severe pneumonia in the children's hospital affiliated to soochow university were selected as the research objects(severe case group),and 1200 children with mild community-acquired pneumoaia(CAP)in the same period were selected as the mild case group,from January 2012 to December 2017.Seven common respiratory viruses(syncytial virus,influenza virus A,influenza virus B,parainfluenza virus 1-3,adenovirus),human boca virus,mycoplasma pneumoniae and bacteria were detected in nasopharyngeal secretions of the two groups.Venous blood of the two groups were tested for mycoplasma pneumoniae IgM.The general situation,early clinical characteristics and laboratory examination characteristics of the children were compared and analyzed by means of medical record review.Results:1.1332 pathogens were detected in 1129 children with severe pneumonia,with a positive rate of 76.09%.578 strains(51.20%)of bacterial pathogens,564 strains(49.96%)of viral pathogens,190 strains(16.83%)of mycoplasma pneumoniae,and 411 cases(36.40%)of mixed infections were detected.The bacteria with the highest detection rate were staphylococcus aureus(35.61%),the virus with the highest detection rate was respiratory syncytial virus(35.61%),and the majority of mixed infections were bacteria with viruses(19.13%).The detection rate of gram-negative bacteria in 2014-2017 was lower than that in 2012-2013.The detection rate of mycoplasma pneumoniae in 2016 was significantly higher.The detection rate of mixed infection in 2015-2017 was higher than that in 2012-2014.Haemophilus influenzae was detected mainly in spring.Parainfluenza virus 3 was detected significantly higher in summer.Acinetobacter baunannii,pseudomonas aeruginosa and human boca virus were detected mainly in autunn.Respiratory syncytial virus was detected mainly in winter.Respiratory syncytial virus were mainly detected in infants.Boca virus was mainly detected in infants.Adenovirus had the highest detection rate in the early school age.My coplasma pneumoniae had the highest detection rate in the early school age and school age.2.The incidence of severe pneumonia was highest in children<3 months(45.70%).The incidence of complications was 72.28%,and respiratory failure(30.99%)was the most common complication.There were 182 premature infants(16.12%),153 low birthweight infants(13.55%)and 42 very low birthweight infants(3.99%).Basic diseases carrying rate was 26.84%(303/1129).Congenital heart disease is the first basic diseases(13.73%),and other basic diseases,in order:anemia(7.17%),nervous system diseases(including cerebral palsy,brain dysplasia,etc.)(2.83%),malnutrition(2.57%),airway abnormalities(including bronchial stenosis,tracheomalacia,etc.)(2.39%),21-the three body syndrome 21 cases(1.86%).The early clinical manifestations(fever,disturbance of consciousness,rale,wheezing sound),blood routine examination and C reactive protein(CRP)in the case group were different from those in the control group.The risk factors for severe pneumonia are:age<3 months,congenital heart disease,malnutrition,basic diseases of 21-trisomy syndrome,wheezing sound,CRP>8mg/L,adenovirus infection and mixed infection(OR=2.261?1.909?4.778?21.253?1.426?1.092?4.528?3.153,P<0.05).3.The average of hospital stay of 1129 children with severe pneumonia was 13.45±9.67,and the incidence of adverse prognosis was 11.16%(126/1129).Univariate analysis showed that the associated risk factors for poor prognosis in severe pneumonia were:age<1 years old,complicationS,presence of underlying diseases,disturbance of consciousness at admission,white blood cell(WBC),neutrophilic granulocyte percentage(N%),troponin>0.O9ng/ml.Multivariate analysis showed that the independent risk factors for poor prognosis in severe pneumonia were:presence of complications,underlying diseases,troponin>0.09ng/ml(OR=4.844?13.750?20.848,P<0.05).Conculsion:1.The bacterial and viral detection rates of children with severe pneumonia were similar.The detection rate of staphylococcus aureus was the highest.The detection rate of gram-negative bacteria was higher than that of gran-negative bacteria,but the annual rate of gram-negative bacteria was lower than that of gram-negative bacteria.Respiratory syncytial virus was the main pathogen.Be aware of the rising trend of mixed infections.2.The risk factors for severe pneumonia are:age<3 months,congenital heart disease,malnutrition,basic diseases of 21-trisomy syndrome,wheezing sound,CRP>8mg/L,adenovirus infection and mixed infection.3.The associated risk factors for poor prognosis in severe pneumonia are:the presence of underlying diseases and complications,troponin>0.09ng/ml. |
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