Clinical research of electron bronchoscopic alveolar lavage in the treatment of children with lobar pneumonia
Objective To investigate the microscopic manifestation and clinical effect of electron bronchoscopic alveolar lavage in the treatment of children with lobar pneumonia.Methods A total of 100 cases of lobar pneumonia hospitalized in the Department of Pediatrics of the Second Affiliated Hospital of Air Force Medical University from January 2017 to June 2022 were retrospectively analyzed.Based on the children's clinical manifestations,physical examination findings,laboratory examination and imaging tests,children underwent electronic bronchoscopy and alveolar lavage.By detecting mycoplasma pneumoniae(MP)in the alveolar lavage fluid,the children were divided into the MP pneumonia group(74 cases)and the non-MP pneumonia group(26 cases).The MP-positive patients were given sensitive antibiotics in time.Clinical symptoms,laboratory findings,chest CT before and after lavage,and prognosis of the children were compared and analyzed to determine the clinical characteristics of pneumonia in the two groups of children.Results The white blood cell count of children in the MP pneumonia group with(7.5±3.3)×109/L was significantly lower than that in the non-MP pneumonia group with(11.4±7.2)×109/L,with a statistically significant difference(t=2.654,P＜0.05);Among 100 cases of children with lobar pneumonia,bronchial mucosal inflammation was the main manifestation observed under electronic bronchoscopy.Specifically,there were 8 cases of bronchial stenosis,44 cases of mucosal congestion,3 cases of mucosal hypertrophy,87 cases of purulent secretion adherence,14 cases of purulent plug obstruction of the bronchial lumen,and 7 cases with other manifestations.The proportion of bronchial stenosis,mucosal congestion,mucosal hypertrophy,purulent secretion adherence,and purulent plug obstruction of the bronchial lumen in the MP pneumonia group was higher than that in the non-MP pneumonia group,and the difference was not statistically significant(P＞0.05).The levels of aspartic transaminase(AST)and α-hydroxybutyrate dehydrogenase(α-HBDH)in the MP pneumonia group were higher than those in the non-MP pneumonia group.The detection rates of right lung inflammation,left lung inflammation,bilateral lung inflammation,and pleural effusion in the MP pneumonia group were all higher than those in the non-MP pneumonia group,but the differences were not statistically significant(P＞0.05).There were no statistically significant differences in the distribution of digestive system involvement,neurological involvement,and renal function damage between the MP pneumonia group and the non-MP pneumonia group(P＞0.05).The positive rate of bacterial culture in the alveolar lavage fluid was low,with only 9 cases(9.0％).In the MP pneumonia group,there were 7 cases of positive culture in the alveolar lavage fluid(9.5％,7/74),while in the non-MP pneumonia group,there were 2 cases of positive culture(7.7％,2/26).The positive rate of MP detected by fluorescence quantitative-polymerase chain reaction(FQ-PCR)method(74 cases,74.0％)was significantly higher than that detected by serum MP-specific antibody(MP-IgM)method(2 cases,2.0％),with a statistically significant difference(x2=107.000,P＜0.05).The time for symptom relief,disappearance of pulmonary rales,adjustment of antibiotics,and length of hospital stay were all longer in the MP pneumonia group compared to the non-MP pneumonia group,but the differences were not statistically significant(P＞0.05).Conclusion The clinical efficacy of electron bronchoscopic alveolar lavage for the treatment of lobar pneumonia in children is definite.Early administration of sensitive antibiotics to MP-positive patients helps improve clinical symptoms and prognosis,enabling proactive guidance on clinical medication,avoiding antibiotic misuse,and reducing hospitalization duration.
万方数据
维普
