Clinical Application Of Fiberoptic Bronchoscopy In The Diagnosis And Treatment Of Pediatric Refractory Pneumonia

Objective:To explore the diagnostic and therapeutic value of fiberoptic bronchoscopy(FB) in pediatric refractory pneumonia.Methods: To select 60 patients who had been confirmed diagnosed of refractory pneumonia at random from the patients who visited respiratory department of Hebei Children's hospital from January, 2008 to November, 2009. We divided them into FB group and control group at random. Each group had 30 patients. All patients of both group were treated with antibiotics, dissipate phlegm, sputum aspiration, thoracentesis and drainage, respiratory support and corresponding underlying diseases treatment, but in the FB group 30 patients were given flexible bronchoscopy as an extra treatment. Observe indexes: (1) For the FB group , we took their sputum before the fiberoptic bronchoscopy for bacterial culture and serum for serum mycoplasma (MP) antibody test and we took their bronchoalveolar lavage fluid during the fiberoptic bronchoscopy for centrifugal culture and MP-PCR. (2) To observe and record what we would see by fiberoptic bronchoscopy and save their images. (3) Chest CT was regularly reviewed for every patient in the two groups in order to know about the situation of lung inflammation absorbing. To judge therapeutic effect by observing the symptom, physical sing of lung and time of total course. (4) To observe the complications during and after the flexible bronchoscopy. The statistical analysis was carried out by Fisher's exact text, rank sum test and two-sample t-test with SPSS 13.0.Results: 1 Diagnosis: 1) Etiological diagnosis: (1) There were 11 samples of sputum culture showed positive (36.7%). They were 2 cases of Pseudomonas aeruginosa, 2 cases of Bacillus aeruginosus, 2 cases of Klebsiella pneumoniae, 1 case of Bacillus coli, 1case of serratia marcescens, 1 case of Staphylococcus aureus, 1 case of Staphylococcus epidermidis and 1 case of Blastomyces albicans. There were 6 of bronchoalveolar lavage fluid culture showed positive (20%). They were 1 case of streptococcus pneumoniae, 1 case of candida tropicalis, 2 cases of pseudomonas aeruginosa, 1 case of klebsiella ozaenae and 1 case of serratia marcescens. Their coincidence was 63.3%. The results of Fisher's exact test showed that P=0.252>0.05, there were no significant difference between sputum culture and bronchoalveolar lavage fluid culture.There were 17 samples of MP-PCR test showed positive (56.7%).While the serum mycoplasma antibody test was 9(30%). Their coincidence was 73.3%. The results of Fisher's exact test showed that P=0.034<0.05, there were a significant difference between MP-PCR and serum mycoplasma antibody test.2) pathogenic diagnosis: Among the 30 patients of FB group, 14 cases were caused by endobronchial chronic inflammation; 9 cases were caused by developmental deformity of bronchus; 6 cases were caused by opening narrowness of bronchus; 1 case was caused by bronchial foreign body. 2 Treatment: For the FB group, 26 patients achieved excellent curative effect, 3 patients achieved certain effect and 1 patient achieved no effect in the FB group; While in the control group, 14 patients achieved excellent curative effect, 8 patients achieved certain effect and 8 patients achieved no effect(P=0.01<0.05). In the FB group, there was only 1 patient who had to be sent to surgery. Among the rest of patients, the shortest course was 29 days and the longest course was 87 days. The mean was 40.80 days. In the control group, there were 8 patient who had to be sent to surgery. Among the rest of patients, the shortest course was 33 days and the longest course was 125 days. The mean was 66.50 days. The comparison of course between FB group and control group was tested by two-samples t-test and showed that t=-40.254, P=0.000<0.05. There was a significant difference between the two groups.3 With reference to safety,the intraoperative complications included 4 cases of mucosal hemorrhage(13.3%), 2 cases of cyanosis(6.7%) and the postoperative complications included 4 cases of cough(13.3%), 2 cases of fever(6.7%),1 case of hoarseness(3.3%). None of the children occurred severe complications such as laryngospasm, massive hemoptysis, respiratory and cardiac arrest and so on.Conclusion: Fiberoptic Bronchoscopy is very important in the diagnosis and treatment of pediatric refractory pneumonia. It can find out the causes intuitive and it can obviously shorten the absorbing time of pneumonia with its lavation and the relative routine treatment. So that it is possible for the patients who had to take the treatment of surgery in the past to recover by means of the conservative medical treatment. In addition, it is very safe for the children. So it is worth of being generalized in pediatrics.