| Objective: Describe and analyze the auscultation characteristics of different syndromes in different stages of lobar pneumonia in children,explore the risk factors of lobar pneumonia in children,and provide reference for early identification and TCM syndrome differentiation of lobar pneumonia in children.Methods: A cross-sectional study was conducted on children with lobar pneumonia who were hospitalized in the pediatric ward of the of Shandong University of Traditional Chinese Medicine from December 2021 to December2022.The general information,symptoms and signs,imaging examination,stage differentiation and auscultation audio were collected and analyzed,and compared with the children with bronchial pneumonia in the same period.The specific steps: Respiratory sound collection,audio processing and labeling,acoustic feature parameter extraction,and a binary logistic regression model for early identification of lobar pneumonia were constructed.Among them,the respiratory sound acquisition application electronic stethoscope ETZ-2 and Aiji auscultation assistant app,audio processing application Cool edit pro software,acoustic characteristic parameter extraction using Praat software,data statistics application SPSS25.0 software.Results:1.In this study,the average hospitalization time of children with lobar pneumonia was 9.75 ± 1.68 days.The median and quartile of hospitalization time of children with lobar pneumonia who were diagnosed and treated in time in the early stage of the disease were 9(8,10)days.The median and quartile of hospitalization time of children with lobar pneumonia who were hospitalized in the critical period were 10(9,12)days.The hospitalization time of children with early admission was shorter than that of children with critical admission(P<0.05).2.There was no significant difference in gender and age distribution of children with lobar pneumonia in each stage(P>0.05).There were significant differences in body temperature,respiration and heart rate among different stages(P < 0.05).Fever,increased heart rate,and increased respiratory rate were seen in the early and extreme periods.The early period was dominated by moderate heat,and the extreme period was dominated by moderate heat and high heat.The body temperature was normal during the recovery period.The respiratory rate in the extreme period was the fastest(corrected P<0.05).3.The median and quartile of bilateral respiratory sound intensity difference in children with early lobar pneumonia were 2.09(0.91,3.13)d B,and those in children with bronchial pneumonia were 0.31(0.06,0.42)d B.The difference of respiratory sound intensity in children with lobar pneumonia was greater than that in children with bronchial pneumonia(P<0.05).4.The auscultation of respiratory sounds in different stages was different(P<0.05).In the early stage,there were no rales in the auscultation of the affected side of the children with wind-cold closed lung syndrome and wind-heat closed lung syndrome.In the extreme stage,the children with phlegm-heat closed lung syndrome and damp-heat closed lung syndrome were the most common in the middle and fine wet rales,and some of them had high-pitched dry rales.In the recovery stage,the auscultation of children with yin deficiency and lung-heat syndrome and lung-spleen qi deficiency syndrome was mostly no rales,low-pitched dry rales and coarse and medium wet rales.5.The sound intensity of the affected side in the early stage was lower than that in the extreme stage and the recovery stage(P<0.05).The sound intensity of children with wind-cold closed lung syndrome and wind-heat closed lung syndrome was lower than that of children with lung-spleen qi deficiency syndrome.In the early stage,the sound intensity of the affected side was lower than that of the healthy side(P<0.05),and the sound intensity of the affected side was lower than that of the healthy side in children with wind-cold closed lung syndrome and wind-heat closed lung syndrome.6.The center of gravity of the respiratory sound spectrum of the affected side was higher than that of the healthy side(P<0.05).7.The standard deviation(frequency)of respiratory sounds in the early and extreme stages of the affected side was higher than that in the recovery period(P<0.05),and the standard deviation(frequency)of children with wind-cold closed lung syndrome and wind-heat closed lung syndrome was higher than that of lung-spleen qi deficiency syndrome.In the early and extreme stages,the standard deviation(frequency)of respiratory sounds on the affected side was higher than that on the healthy side(P<0.05),and the standard deviation(frequency)on the affected side was higher than that on the healthy side in children with wind-heat blocking lung syndrome and phlegm-heat blocking lung syndrome.8.Binary logistic regression was performed on the intensity difference of bilateral respiratory sounds between lobar pneumonia and bronchial pneumonia.It was found that the intensity difference of bilateral respiratory sounds was a risk factor for lobar pneumonia(P<0.05).For each additional unit of bilateral respiratory sound intensity difference,the probability of diagnosis of lobar pneumonia increased by 7.641 times.Conclusion:1.The course of hospitalization of children with lobar pneumonia diagnosed and treated in the early stage of the disease is shorter than that of children hospitalized in the extreme stage,indicating that early diagnosis and treatment can significantly shorten the course of disease in children with lobar pneumonia.2.The early,extreme and recovery stages of the disease have good discrimination in body temperature,heart rate and respiratory rate,indicating that the staging criteria of lobar pneumonia set in this study are in line with clinical practice.3.Compared with bronchial pneumonia,the difference of bilateral respiratory sound intensity in early lobar pneumonia is greater.In the early stage,the respiratory sounds of the affected side in children with wind-cold closed lung syndrome and wind-heat closed lung syndrome were lower than those of the healthy side,and the respiratory sounds of the affected side in the early stage were lower than those in the extreme and recovery periods.The difference of bilateral respiratory sound intensity is helpful for early identification of this disease.4.The difference of the center of gravity of bilateral respiratory sound spectrum in children with phlegm-heat obstructing lung syndrome is greater than that of damp-heat obstructing lung syndrome.By observing the difference of the center of gravity of bilateral respiratory sound spectrum,it can be used to assist in the identification of phlegm-heat obstructing lung syndrome and damp-heat obstructing lung syndrome in lobar pneumonia.5.The standard deviation(frequency)of respiratory sounds in the early and extreme periods of the affected side was higher than that in the recovery period,and the standard deviation(frequency)of respiratory sounds in the early and extreme periods was higher than that in the healthy side.By analyzing the standard deviation(frequency)of each period and the difference between the affected side and the healthy side in each period,it is helpful to distinguish the convalescent lobar pneumonia.6.By analyzing the acoustic index characteristics of various types of rales in lobar pneumonia,it is helpful to further summarize the rules of auscultation characteristics of lobar pneumonia in children.7.For the identification of lobar pneumonia and bronchial pneumonia in children,a binary logistic regression model can be constructed based on the difference of bilateral respiratory sound intensity to predict the possibility of lobar pneumonia in children,and the prediction accuracy is about 80.0%. |
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