可弯曲支气管镜联合快速现场评价技术对儿童难治性肺炎的诊断价值

Diagnostic value of flexible bronchoscope combined with rapid on site evaluation technique in children with refractory pneumonia

目的探讨可弯曲支气管镜联合快速现场评价技术(rapid on site evaluation,ROSE)在儿童难治性肺炎中的诊断价值,为临床快速诊断提供参考依据。方法回顾性分析2017年11月至2022年2月中山市博爱医院收治的儿童难治性肺炎并行可弯曲支气管镜检查的患儿,根据是否行ROSE检查分为单纯支气管镜组及支气管镜+ROSE组,比较两组患儿的相关检查结果,并将出院时的确诊结果分别与两组现场检查结果比较,计算Kappa值并绘制受试者工作特征(ROC)曲线,评价诊断效果。结果共纳入351例患儿,其中支气管镜+ROSE组172例,单纯支气管镜组179例。两组首次支气管镜检查时间差异无统计学意义(t=-0.672,P>0.05),但支气管镜+ROSE组需多次检查的患儿比例较单纯支气管镜组明显下降,差异有统计学意义(χ2=4.407,P<0.05);支气管镜+ROSE组现场检查结果的灵敏度及特异度分别为91.4%及78.6%,单纯支气管镜组现场检查结果的灵敏度及特异度分别为63.6%及68.8%,与单纯支气管镜组相比,支气管镜+ROSE组具有更高的诊断效能(符合率:90.3%vs.64.1%;Kappa:0.511 vs.0.133;ROC曲线下面积:0.846 vs.0.662)。结论可弯曲支气管镜联合ROSE技术可显著提高儿童难治性肺炎的诊断效能,有效减少支气管镜的多次检查,具有临床推广价值。

Objective To explore the diagnostic value of flexible bronchoscopy combined with rapid on-site evaluation(ROSE)in children with refractory pneumonia,and provide reference for rapid clinical diagnosis.Methods Retros-pective analysis was performed in children with refractory pneumonia receiving flexible bronchoscopy,who were admitted to Boai Hospital of Zhongshan from November 2017 to February 2022.According to whether ROSE examination was performed,they were divided into the simple bronchoscopy group and the bronchoscopy+ROSE group.The relevant examination results in the two groups were compared,and the confirmed diagnosis results at discharge were compared with the on-site examination results in the two groups.Kappa values were calculated and the working characteristics curve of subjects(ROC)was drawn to evaluate the diagnostic effect.Results A total of 351 patients were included,including 172 cases in the bronchoscope+ROSE group and 179 cases in the simple bronchoscope group.There was no significant difference in the first bronchoscopy time between the two groups(t=-0.672,P>0.05),but the proportion of patients requiring multiple examinations in the bronchoscope+ROSE group was significantly lower than that in the simple bronchoscope group,and the difference was statistically significant(χ2=4.407,P<0.05);the sensitivity and specificity of the on-site examination results in the bronchoscopy+ROSE group were 91.4%and 78.6%,respectively,and the sensitivity and specificity of the on-site examination results in the bronchoscopy alone group were 63.6%and 68.8%,respectively.Compared with the bronchoscopy alone group,the bronchoscopy+ROSE group had higher diagnostic efficency(coincidence rate:90.3%vs.64.1%;Kappa:0.511 vs.0.133;AUC:0.846 vs.0.662).Conclusion Flexible bronchoscope combined with ROSE technology can significantly improve the diagnostic efficiency of refractory pneumonia in children and effectively reduce the number of bronchoscopy examinations,which is worthy of clinical promotion.