| Objective:To explore the clinical characteristics of lobar pneumonia in children,and provide data reference for clinical diagnosis and treatment of this disease,so as to improve the diagnostic efficiency,guide and standardize the treatment methods,and improve the clinical efficacyMethods:the medical records of 108 children diagnosed with lobar pneumonia who were hospitalized in the pediatric respiratory ward of the Second Hospital of Shandong University from December 2017 to November 2018 were selected as the study objects.Mainly including gender,age,main symptoms and signs;laboratory examination results,blood routine,liver and kidney function,high sensitivity Creactive protein,procalcitonin,pathogen detection results,chest DR,etc.;treatment methods,days of antibiotic use,types of antibiotic use,fiberoptic bronchoscopy(fiberoptic bronchoscopy)diagnosis and treatment,etc;Treatment outcome,length of hospitalization,etc.SPSS 22.0 statistical software was used for statistical analysis.The measurement data were t ested by two independent samples;X2 test was used for counting data.Spearman correlation analysis was used to analyze the correlation between the two factors.The difference was statistically significant when P<0.05.Results:(1)The proportion of children with lobar pneumonia in 2018(11.5%)was higher than that in 2016(9.5%)and 2017(9.3%),and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that the proportion of patients with lobar pneumonia increased with the age of children,and there was a positive correlation between them(r=0.659,P=0.023).The proportion of children in males was higher than that in females.The incidence rate in spring(10.7%),autumn(11.3%)and winter(12.9%)is higher than that in summer(8.9%).Among 108 children with lobar pneumonia on chest X-ray,the shortest course before admission was 1 day,and the longest course was 55 days.(2)Clinical symptoms and signs:All 108 children with lobar pneumonia had clinical manifestations of fever,and there was no obvious pattern of heat type.The main symptoms of 106 children were cough and sputum production,accounting for 98.1%.In 76 cases(70.3%)of patients with lung auscultation,there was varying degrees of attenuation of breathing sounds in the lungs.)(3)Laboratory tests:A total of 92 of the 108 children with lobar pneumonia(85.2%)detected the causative agent.Mycoplasma pneumoniae was the main causative agent in 51 cases(55.4%).The comparison of pathogens with different fever levels showed that when the body temperature was 37.3-38.0℃,bacteria and Mycoplasma pneumoniae accounted for the highest proportion of pyrogens,and when the body temperature was 37.3-38.0℃,the proportion of uncertain pathogens and Mycoplasma pneumoniae as pyrogens was the highest,and when the body temperature was>39.5℃,bacteria+Mycoplasma pneumoniae+viral infection accounted for the highest proportion as pyrogens.The results of Mycoplasma pneumoniae detection showed that the detection rate of Mycoplasma pneumoniae antibody and Mycoplasma pneumoniae nucleic acid detection was not statistically significant(P>0.05).There was a statistically significant difference in the positive rate of Mycoplasma pneumoniae at different ages(P<0.05),from the highest to the lowest>the 7-year-old group was higher than the 4-6 year old group and the 1-3 year old group.and higher in the group of 0-1 years.The results of viral testing showed that a total of 72 study subjects completed viral antibody or viral nucleic acid testing,and a total of 21 virus-positive children were detected,with a positive rate of 29.2%.The results of bacterial culture showed that a total of 62 subjects in this study completed the bacterial culture of specimens,and 25 positive strains were detected,with a positive rate of 40.3%.The most commonly detected are Streptococcus pneumoniae,Staphylococcus aureus,and Klebsiella pneumoniae.The comparison of the detection rate of different specimen cultures showed that the detection rate was higher to the lowest in pleural fluid culture,alveolar lavage fluid culture detection rate was higher than sputum culture detection rate higher than blood culture detection rate(P<0.05).The results of hs-CRP showed that the average value of hs-CRP was 21.57±18.37 mg/L,and the children with hs-CRP higher than normal value(0-10 mg/L)were 75 patients(73.1%),and the hs-CRP in the MP group was higher than that in the non-MP group.There were 8 children with lactate dehydrogenase(LDH)>300 U/L,and 6 of these 8 children turned to RMPP.)(4)Chest DR showed that the proportion of upper field of right lung was the highest(29.9%).The chest radiographs of 10 cases showed delayed remission.(5)Fiber bronchoscopy was completed in 31 children,including 8 cases of intrabronchial sputum plugs,5 cases of plastic bronchitis,3 cases of bronchial stenosis,and 2 cases of bronchosia.The duration of fever and the disappearance of cough symptoms in the alveolar lavage treatment group were less than in the nonalveolar lavage treatment group(P<0.05)(6)Complications:83 of the 108 children(76.9%)had complications and 104 complications occurred.There were 63 cases(60.6%)of respiratory complications.There were 41 extrapulmonary complications(39.4%).(7)Outcome:51 cases were cured and discharged from the hospital,38 cases were discharged for improvement,and a total of 89 cases were effective in treatment,with an effective rate of 82.4%;19 cases were not cured.Conclusion:(1)The incidence rate of lobar pneumonia in children in our hospital is on the increase.(2)With the increase of children’s age,the proportion of patients with lobar pneumonia increased,and the two had a positive correlation.(3)The causative agent of lobar pneumonia in children is mainly Mycoplasma pneumoniae.(4)hs-CRP has a certain hint effect on lobar pneumonia in children with MP as the causative agent,and LDH may be a predictive indicator for the conversion of lobar pneumonia in children to RMPP.(5)The therapeutic effect of combined fiberoptic bronchoscopy is better. |
