Research Of Fiberoptic Bronchoscopy In The Diagnosis And Treatment Of Mycoplasma Pneumoniae Pneumonia In Children

Objective: to study the value of fiberoptic bronchoscopy in the diagnosisand treatment of mycoplasma pneumoniae pneumonia in children.Methods: We analyzed 168 cases of children with mycoplasmapneumoniae pneumonia who accepted the macrolide antibiotics treatment andfiber bronchoscope examination in Hebei children’s hospital from March2012 to September 2014. The cases who were still persistent fever and lungimaging aggravating after macrolide treatment 7 days or more accepted theglucocorticoid treatment. We observed the airway mucosal morphologychange by fiberoptic bronchoscopy. According to the treatment, the cases wererandomly divided into control group and observation group. The control groupwas given macrolide treatment, while the observation group based onmacrolide treatment was given fiber bronchoscope. According to thepathological changes of children with bronchial morphology change givendifferent drugs, and repeatedly lavage, wool brush wash. Bronchoalveolarlavage fluid was tested. The efficient treatment, clinical symptoms disappeartime and inflammatory cytokines in serum before and after the treatment(TNFalpha, IL- 6 and IL- 8) levels were compared in two groups. In order toensure the fiber bronchoscope smoothly operation and good treatment effect,we should do preparatory work the preoperative and postoperative to ensurethat no serious postoperative complications, more conducive to the fiberbronchoscope operation smoothly.All data was analyzed using SPSS13.0 statistical analysis software.Measurement data using x + s, measurement data using t test and count databy chi-square test.Results:1 The change of airway mucosa morphology: the results of bronchoscopyexamination showed sbronchial mucosal hyperemia and edema, and viscoussecretion in all patients. The segmental bronchus swelling stenosis in 98 cases(58.33%), mucosal erosion in 51 cases(30.36%), mucous bolt obstruction in38 cases(22.62%), 33 cases of mucosal petechial hemorrhage(19.64%), 40 cases of mucosal nodule like protrusions(23.81%), longitudinal folds in 26cases(15.48%), 12 cases of tracheal mucosa vascular explicit(7.14%).2 BALF laboratory examination: BALF precipitation observation showeda lot of epithelial cells and inflammatory cells under microscope, among ofthem the neutrophil and lymphocyte most.162 patients the BALFneutrophil>50%(96.43%),of which 159 cases(94.6%) of neutrophil number >90%, 6 cases of lymphocytic >20%. BALF MP-PCR positive in 139 cases(82.74%), the MP-PCR detection was superior to serum MP antibodydetection in diagnosis of Mycoplasma infection. Lavage microbiologicalculture were detected in 6 strains, including Streptococcus pneumoniae in 2strains, Haemophilus influenzae in 2 strains, Staphylococcus aureus in 1strains, Klebsiella pneumonia in 1 strains, the positive rate was only 3.6%.3 The biopsy pathology results: the pathological manifestations of 5 casesreceived by branchofiberoscope nodule biopsy showed neutrophils,lymphocytes and plasma cells infiltrated in epithelial tissue, suggesting thatinflammatory; electron microscopy in 1 cases with the decrease of the numberof cilia, 1 cases with cilia fusion.4 Treatment: The fiber bronchoscope could fully remove the airwayinflammatory secretions, pus, sputum bolt, and quickly relieve the clinicalsymptoms. The effective rate of the treatment control group and observationgroup were respectively 76.19% and 95.23%, the observation groupsignificantly higher than the control group. The difference was statisticallysignificant(P<0.05). The disappearing time of clinical symptoms was shorterthan the control group, and the difference was statistically significant(P<0.05).After treatment, levels of inflammatory cytokines TNF- alpha, IL-6 and IL-8was significantly lower than that before treatment in the observation group andthe control group, and the observation group was more significant. Thedifference was statistically significant(P<0.05).5 Security: All of the patients were able to successfully complete thefiberoptic bronchoscopy. The complications were 12 cases of nasalhemorrhage(4.7%), 3 cases of cyanosis(1.2%), 1 cases of bronchial mucosalbleeding(0.4%), 9 cases of postoperative fever(3.5%) and 3 cases of cough(1.2%). Intraoperative and postoperative complications after symptomatictreatment alleviated. All patients had no serious complications such as cardiacand respiratory arrest, life-threatening hemoptysis..Conclusion:1 Fiberoptic bronchoscopy provides the basis for clinical diagnosis andnew treatment concept of diagnosis and treatment of children with myco-plasma pneumonia. It can observe the morphological changes of lesionmucosa under direct vision. The serum TNF-, IL-6 and IL-8 alpha inflame-matory factor levels significantly decreased postoperation. Bronchofib-roscope lavage can effectively remove the lung inflammatory mediators,reduce pulmonary and extrapulmonary inflammatory reaction. It has importantclinical significance in the diagnosis and treatment of mycoplasma pneumoniaand greatly shorten the clinical symptom remission time and hospitalizationtime.2 In addition the accuracy and sensitivity of MP-PCR of bronchoalveolarlavage fluid greatly improve the level of early diagnosis of Mycoplasmapneumoniae pneumonia and provide the basis for early intervention.3 Fiberoptic bronchoscopy is quite safe and reliable. Its operation issimple, safe, less trauma and have a remarkable economic benefit and socialbenefit. It is worth popularization and application in pediatrics.