Objective:To better understand the clinical characteristics of children with pneumocystis pneumonia(PCP).Methods:Seven cases of non-human immunodeficiency virus infected children with PCP admitted to pediatric intensive care unit(PICU) at Xi′an Children′s Hospital from January 1, 2019 to December 31, 2019 were enrolled.Clinical findings, laboratory examination results, diagnosis, treatment, and outcome data were retrospectively reviewed.Results:There were seven children enrolled in this study including six boys and one girl.The average age was(6.09±3.80)years.Six patients received a long-term steroid or immunosuppressive therapy, and the average duration of medication was(80±30)days.One patient was eventually diagnosed with immunodeficiency disease despite no history of steroid and immunosuppressive therapy.Fever, cough and progressive dyspnea were the main manifestations.The pulmonary signs were not obvious, however, the chest radiographs showed serious ground glass changes.Laboratory examination showed that white blood cell counts were normal, lymphocyte counts were decreased to varying degrees, while C-reactive protein, calcitonin and lipopolysaccharide increased slightly or normal.Lactate dehydrogenase significantly increased and PaO 2/FiO 2 decreased, respectively.All children combined with different degrees of heart, liver and digestive tract damage.Pneumocystis jirovecii infection was diagnosed by metagenomics next-generation sequencing(mNGS), of which one case was detected by bronchoalveolar lavage fluid, and the remaining six cases were detected by peripheral blood.After entering PICU, mechanical ventilation, intravenous injection of human immunoglobulin, and continuous renal replacement therapy were performed.None of the children used TMP-SMZ for prophylaxis outside the hospital.Among them, one case was diagnosed with PCP before entering PICU and was given TMP-SMZ for 20 days, while the remaining six patients started to receive TMP-SMZ after entering PICU.Finally, one patient was cured, three died and another three cases died after giving up treatment.The average hospitalization days were(11.28±8.78)days, and the average hospitalization costs were (78, 000±24, 000) RMB. Conclusion:Children with non-human immunodeficiency virus infected PCP usually have underlying diseases or immunodeficiency diseases.Due to non-specific manifestations, rapid progression and high mortality, clinicians should pay more attention to it.It is necessary to dynamically observe the respiratory symptoms, perform mNGS as soon as possible, and give TMP-SMZ treatment in time.TMP-SMZ prophylaxis can be given to patients who are highly suspected of PCP but unable to perform pathogenic examinations.

Objective To observe the application value of dexmedetomidine combined with different doses of sufentanil in clear tracheal intubation on elderly patients.Methods From October 2014 to September 2016,42 elderly patients with difficult trachea in the People's Hospital of Taierzhuang District were selected and divided into observation group 1,observation group 2 and observation group 3 according to the random table method,with 14 cases in each group.The patients in three groups were intravenously given the same dose of dexmedetomidine injection,and on this basis,the three groups were intravenously given different doses of sufentanil injection.The one-time intubation success rate and the mean arterial pressure(MAP),heart rate(HR),electrocardiogram(ECG),blood oxygen saturation(SpO2),end-tidal carbon dioxide monitoring(PETCO2),and Ramsay sedation score before intubation,immediately after intubation,5min after intubation and immediately after extubation were compared.Results The one-time intubation success rates of the observation group 1,group 2 and group 3 were 64.29％,71.43％and 57.14％,respectively,and there was no statistically significant difference among the three groups(P>0.05).Immediately after intubation,the MAP of the observation group 1,group 2 and group 3 were(84.62 ±5.03)mmHg,(98.97 ±6.20)mmHg and(82.92 ± 5.10)mmHg,HR were(67.94 ±2.85)times/min,(69.89 ±3.55)times/min and(66.47 ±4.22)times/min,respectively,SpO2 were(94.17 ±5.14)％,(97.45 ±3.87)％and(92.84 ±5.30)％,respectively,which were all decreased significantly compared with those before intubation(t=6.098,1.831,6.719,4.188,2.139,4.748,2.705,1.752,3.720,all P<0.05).At 5min after intubation,the MAP of the observation group 1,group 2 and group 3 were(83.94 ±3.81)mmHg,(97.87 ±3.34)mmHg and(81.87 ±3.70)mmHg,respectively,HR were(66.38 ± 3.05)times/min,(68.80 ±3.92)times/min and(65.37 ±4.48)times/min,respectively,SpO2 were(92.81 ± 5.53)％,(96.95 ±4.90)％and(90.17 ±4.51)％,respectively,which were all decreased significantly compared with before intubation(t=6.601,2.410,7.402,4.432,2.736,5.236,3.294,1.911,5.660,all P <0.05).The Ramsay sedation score of the observation group 2 was(3.16 ±0.36)points,which was higher than(1.78 ±0.29)points of the observation group 1(t=8.716,P=0.000),but lower than(5.03 ±0.72)points of the observation group 3(t=5.503,P=0.000).Conclusion Dexmedetomidine combined with 0.25μg/kg sufentanil in awake nasal intubation on elderly patients has the least effect on vital signs and hemodynamics,and the sedation depth is moderate.