Progresses of treatment of children with severe /refractory mycoplasma pneumoniae pneumonia / 国际儿科学杂志

Mycoplasma pneumoniae is a common pathogen leading to pediatdc respiratory infection,which belongs to self-limited disease and has a great response to macrolide antibiotics.In recent years,the morbidity of pediatric severe/refractory mycoplasma pneumoniae pneumonia has been increasing.Some of the patients suffer sequelae,even die.This disease seriously threatens the health of children.This review will introduce the treatment of mycoplasma pneumoniae pneumonia including general therapy,antibiotics,immunosuppressor,fiber bronchoscope and traditional Chinese medicine.

Use of right bronchial occluder placement and positioning under left-lateral position / 安徽医科大学学报

40 patients to undergo video-assisted thoracoscopic radical resection of esophageal carcinoma through right thoracotomy were randomly divided intogroup of horizontal position (group S) and group left lateral position (group L),and with 20 patients in each group respectively.The bronchial occluder was placed into the right bronchia guided by fiber bronchoscope after tracheal intubation following the anesthesia induction in each group,while the occluder of group S was placed under the left lateral position,while that of group L was inserted under horizontal position.Then,we observed including the occluder displacement,the number of the use of fiber bronchoscope and the satisfaction degree of pulmonary collapse in the two groups.The differences of the occluder displacement number under lateral position,the number of the use of fiber bronchoscope in the two groups were statistically significant,while there was no statistical difference in the satisfaction degree of pulmonary collapse between the two groups.The fiber bronchoscope-guided bronchial occluder placement into the right bronchia under left-lateral position is able to prevent the displacement during lateral position process and reduce the number of use of fiber bronchoscope,which is deserved to be recommended into the clinical practice.

Characteristics of refractory Mycoplasma pneumoniae pneumonia and efficacy of the therapy with glucocorticoids in children / 国际儿科学杂志

Objective To investigate the clinical,laboratory and imaging characterstics of refractory Mycoplasma pneumoniae pneumonia(RMPP) with lobar pneumonia change and efficacy of the therapy with different doses of glucocorticoids in children.Methods The clinical data of 103 children with Mycoplasma pneumoniae pneumonia(MPP) between September 2015 and February 2016 were investigated.Among the 103 children,there were 52 cases of RMPP and 51 cases of non-refractory MPP.The clinical features,laboratory examination and imaging characteristics were compared between the two groups.For the children with RMPP,the change of clinical symptoms and imaging were observed after the treatment with routine dose and large dose of glucocorticoids.Then,for the children with poor imaging,fiber bronchoscope can be used,the differences of airway mucosa injury and immune cells in the bronchoavleolar lavage fluid were compared after the treatment with routine dose and large dose of glucocorticoids.Results The children in the RMPP group had longer febrile time and hospital stay and were more likely to suffer from extrapulmonary complications.Peripheral blood neutrophil count,CRP,PCT,LDH and D-dimers were higher than these in the MPP group.At the same time it was more common that two or more pulmonary lobes were involved synchronally or pleural effusion appeared,the differences were statistically significant(P ＜ 0.05);There were no statistical differences that the clinical symptoms,imaging change,airway mucosa injury and the proportion of immune cells in BALF between the children in the RMPP group after the treatment with routine dose and large dose of glucocorticoids (P ＞ 0.05).Conclusion It should be alert to the occurence of RMPP in children with MPP when there was a persistent fever,extrapulmonary complications,increased levels of inflammatory index significantly,pleural effusion or two or more pulmonary lobes involvement.Compared with the treatment with routine dose of glucocorticoids in children with RMPP,it does not show a clear advantage with large dose of glucocorticoids on the clinical symptoms and inhibition of airway mucosa injury.

Clinical application of fiber bronchoscope to take bronchial foreign body in children under general anesthesia with laryngeal mask airway / 中国内镜杂志

Objective To evaluate the efficacy and safety of fiber bronchoscope to take bronchial foreign body in children under general anesthesia with laryngeal mask airway. Methods 57 cases of fiber bronchoscope to take bronchial foreign body in children under general anesthesia with laryngeal mask airway were analyzed in 6 years. Results 57 cases of bronchial foreign body were removed successfully, all cases of SpO2, heart rate and other vital signs were stable, 5 cases of forceps to take granulation tissue appeared a little blood, there were no complications such as edema of the larynx, laryngospasm, cardiopulmonary arrest. Conclusions It is safe and effective for fiber bronchoscope to take bronchial foreign body in children under general anesthesia with laryngeal mask airway, and it is worth of generalization.

Application and safety of bed side flexible fiberoptic bronchoscopy in PICU / 中国小儿急救医学

Objective To id scuss the role and safety of fiberoptic bronchoscopy for diagnosing and treating respiratory dsi ease in PICU.Methods A total of 95 eil gible children with respri atory diseases admi-tted ni PICU of Hu′nan Prvo inec Children′s Hospital were enroll ed in this retrospectvi e study from January 2013t o December 2013, and the efficacy and complications of fiberoptic bronchoscopy were assessed.Results A total of 95 children underwented bronchoscopy 112 timest, he most common of microscopic examination resutl s was tracheal bronchitis ( 62.1%) , followed by congenital airway abnormality ( 21.1%); 58 times (56.9%) showed becteria positive in 102 times lavage and sputum culture results, including 16 times (27.6%) of Klebsiella pneumoniae bacteria,12 times(20.7%) of Acinetobacter baumannii.After under-wenting bronchoscopy and lavage wash,blood gas analysis of pH value,PaO2 ,PaCO2 ,SaO2 had significant improvement than before( P0.05).The inrt aopear tive and postoperative transient comlp ications were obserev d in 38 times (33.9%).Conclusion The appil cation of fiberoptic bronchoscopy for diagnosing and ter ating disease in PICU has a cetr ia n value, its vo erall safety is reliable.

Clinical feature,lung imaging and bronchoscope characteristics analysis of infant bronchial foreign body / 国际儿科学杂志

Objective To investigate the advantages of pediatric electronic fiber bronchoscope ( FBO) in the infant bronchial foreign body,discuss the clinical features of infant bronchial foreign body,lung imaging characteristics and the kinds of microscopically position,the change of airway mucosa after stimulation by for-eign body under local anesthesia in 30 cases of infant bronchial foreign body. Methods Thirty cases,aged 0 to 3 years,were collected from September to December,2014. All of them were with foreign bodies examined by FBO in pediatric bronchoscopy room in Shengjing Hospital of China Medical University. Results In all infants, 6 cases (20. 0%) without history of inhaled foreign bodies and 24 cases (80. 0%) with a record history of in-haled. In the aspects of signs:normal breath sounds with a history of no choking cough in children were 2 cases (6. 7%) ,wheezing sounds were 3 patients (10. 0%) and weakened side breath sound was 1 case (3. 3%);with a history of choking cough in children,6 cases(20. 0%) with normal breath sounds,12 cases(40. 0%) with wheez-ing,6 cases(20. 0%) with lateral breath sounds less. Lung imaging characteristics was lack of specific perform-ance:only a case of all(n=30)show foreign body directly. Otherwise,other 29 cases had no specificity. Lung em-physema in 13 cases (43. 3%) is the main characteristic,while normal imaging findings in 2 cases (6. 7%). For-eign bodies in 19 cases were in the left lung (63. 4%) and 21 cases(70. 0%) of foreign body stimulated granula-tion inside airway,necrosis sputum bolt in distal obstruction of airway occured in 5 cases (16. 7%). Inhalled time of foreign body in airway was 4. 5 [2. 8,12. 5] day and inhalled time of foreign body in airway correlation coefficient with granulation hyperplasia(r=0. 688,P=0. 000),there was a significant correlation. Main adverse reaction was low oxygen in 6 cases (16. 7%). Conclusion The diagnostic accuracy of FBO under local anesthesia on children is high-er than other methods,and the FBO bronchial foreign bodies under local anesthesia is a safe and effective method.

Case Analysis of Budesonide Suspension Combined with Fiber Bronchoscope for Influenza A(H1N1/H3N2) Infection Complicated with Plastic Bronchitis in Children / 中国药房

OBJECTIVE:To analyze the pathological characteristics and therapy method for influenza A(H1N1/H3N2)in-fection complicated with plastic bronchitis (PB). METHODS:Clinical information of 3 children with influenza A (H1N1/H3N2) infection complicated with PB were reported to summarize the experience of aerosol inhalation of Budesonide suspen-sion combined with fiber bronchoscope lavage. Based on literatures,this rare disease were analyzed. RESULTS:Among 3 chil-dren,2 children suffered from influenza A H1N1 infection and one child influenza A H3N2 infection complicated with PB;2 of them got basic disease,i.e. bronchial asthma and primary renal syndrome. 3 children were diagnosed as severe pneumonia,re-spiratory failure and pulmonary atelectasis;2 of them suffered from mediastinal emphesema and subcutaneous emphysema. The branchlike foreign bodies,removed by fiber bronchoscope,were fibrin complicated with neutrophile granulocyte,eosinophile granulocyte and leukomonocyte infiltration by pathological examinations. It was diagnosed as PB. 3 children received symptom-atic support treatment as assisted respiration,respiratory tract management and anti-infective treatment,and aerosol inhalation of Budesonide suspension combined with fiber bronchoscope lavage. And then they were cured and discharged from the hospi-tal. CONCLUSIONS:PB is one complication of influenza A pneumonia and severe. Fiber bronchoscope must be carried out as soon as possible based on aerosol inhalation of Budesonide suspension once PB is suspected,so as to diagnose early and treat promptly.

Effect of lidocaine on pseudomonas aeruginosa in bronchial lavage fluid * / 重庆医学

Objective To investigate the influence of application of local anesthesia with lidocaine on bronchial lavage fluid (BLF) pseudomonas aeruginosa culture and drug sensitivity in cases with lung infection .Methods Two hundred and seventy speci-men of BLF were collected from 135 patients with infection of lung .And BLF were collected directly from right-broncho in control group ,and from left-broncho in lidocaine group .The outcome of pseudomonas aeruginosa culture and drug sensitivity were com-pared in the two groups .Results Fourty-two cases were postitive in BLF pseudomonas aeruginosa culture in the control group ,and 40 cases were postitive in lidocaine group .The positive rates were 31 .11% and 29 .63% ,respectively .There were no significance between the two groups (P<0 .001) .Compared with the control group ,the sensitive strains of pseudomonas aeruginosa were obvi-ously less and the drug tolerance strains were much more in lidocaine group for Ciprofloxacin and Levofloxacin (P<0 .05) .Howev-er ,there were no influence for drugs such as Piperacillin/Tazobactam and Ceftazidime ,etc .Conclusion 2% lidocaine has no influ-ence on the outcome of BLF pseudomonas aeruginosa culture .But it may reduce the drug sensitivity of Ciprofloxacin and Levofloxa-cin in cases with infection of lung .