Clinical Application Of Bronchoscopy In 45 Cases Of Necrotic Pneumonia In Children

Objective: The significance of bronchoscopy in the treatment and diagnosis of necrotizing pneumonia was evaluated by studying the clinical data,auxiliary examinations,treatment methods and prognosis of 45 children with necrotizing pneumonia.Methods: From May 2016 to May 2018,45 children with necrotizing pneumonia and 55 children with lobular pneumonia were admitted to the second pediatric respiratory department of the first hospital of jilin university,and all of them received bronchoscopy.According to the CT findings,the lung was divided into lobular pneumonia group(55 cases in total)and necrotizing pneumonia group(45 cases in total).According to the time of the first bronchoscopy,the patients could be divided into the early group(17 cases)who received bronchoscopy within 10 days of the course of disease,and the late group(28 cases)who received bronchoscopy within 10 days of the course of disease.Results: 1.Gender and age: there were no statistically significant differences in gender and age between the two groups(P > 0.05),and the age ofonset of the two groups was more than 6 years old.2.Clinical symptoms and signs :(1)there was no statistically significant difference between the two.(2)heat process: necrotizing pneumonia group was significantly higher than lobar pneumonia group(P < 0.05).(3)signs: the children with necrotizing pneumonia presented pulmonary signs such as dyspnea,reduced breath sound and dullness or solid sound of percussion.3.Laboratory examination: compared with the necrotizing pneumonia group and the lobar pneumonia group,there were no statistically significant differences in the total number of white blood cells(WBC),CRP and d-dimer in peripheral blood.4.Imaging examination: lung CT: there were 35 cases of unilateral lung involvement,including 24 cases of right lung involvement,11 cases of left lung involvement,and 10 cases of bilateral lung involvement.The mean time of necrosis was 16.7d(range 8-32d).Chest ultrasound: a total of 23 children with necrotizing pneumonia had pleural effusion.Pleural effusion was present in 7 patients with lobar pneumonia.5.Bronchoscopy: bronchoscopy and alveolar lavage were performed in all the 45 children with necrotizing pneumonia,and the alveolar lavage fluid presented as mitang cloudy liquid.The time interval between the first mitang change and the first lung CT or chest X-ray indicating large inflammation of the lung was the standard,with an average time of 8.4d(2-25d).Conclusion: 1.Alveolar lavage rice soup type changes,tracheal occlusion,phlegm plug blockage,lumen stenosis for the early diagnosis of necrotizing pneumonia have guiding significance.2.ROS(rapid field evaluation)examination showed cell wiredrawing,nuclear shrinkage and fragmentation,indicating necrotic changes.3.Early application of bronchoscopy in the treatment of necrotizing pneumonia,both to reduce the rate of surgery,but also to reduce the incidence of bronchitis obliteration.