双源CT三维重建在儿童喘息性疾病中的诊断价值

目的 探讨双源CT 三维重建对病因可疑的儿童喘息性疾病的诊断价值。方法 对我院儿科于2018 年1 月～2019 年6 月收治的50 例表现为喘息、胸片或多层螺旋CT（Multi-slice computer tomography,MSCT）考虑为支气管肺炎或支气管炎、怀疑误诊或漏诊的患儿行DSCT 三维气道重建检查,对比DSCT 三维气道重建检查前的入院诊断与检查后的诊断是否相同。结果 入院诊断为支气管肺炎的38 例中于检查后发现合并支气管狭窄3 例、合并气管软化1 例、合并肺气肿2 例、合并肺不张3 例、合并胸腔积液3 例,发现气道异物3 例,发现肺结核1 例。入院诊断为毛细支气管炎的5 例中,于检查后发现为闭塞性细支气管炎1 例。入院诊断为支气管炎7 例中,检查后发现支气管肺炎1 例,发现气管性支气管炎2 例。共发现误诊8 例,误诊率为16%,发现漏诊12 例,漏诊率为24%。结论 DSCT 气道三维重建技术能清晰显示气道及其周围组织的结构,对明确小儿喘息性疾病的病因诊断、减少误诊及漏诊有着重要的临床价值。     

Swyer-James-MacLeod syndrome

Swyer-James-MacLeod syndrome is a rare complication of respiratory tract infection occurring in early childhood. We report two children with chronic cough and recurrent wheezing who fulfilled the diagnostic criteria for this disorder: 1) Unilateral loss of lung volume with hyperlucency on chest x-ray. 2) Unilateral reduction in vascularity on CT scan of the chest. 3) Unilateral loss of perfusion on Technetium 99c lung scan.     

喘息性支气管肺炎患儿血清钙、磷水平及碱性磷酸酶活性检测

目的:探讨支气管肺炎患儿喘息与血清钙、磷水平及碱性磷酸酶活性的相关性。方法:91例支气管肺炎患儿分为喘息组和非喘息组,分别测定血清钙、磷浓度及碱性磷酸酶活性,并对测定结果进行分析。结果:喘息组血清钙磷浓度均低于非喘息组;而血清钙、磷及碱性磷酸酶阳性率均明显高于非喘息组。结论:钙、磷代谢紊乱与支气管肺炎患儿喘息的发生具有密切相关性。对喘息性支气管肺炎患儿应进行血清钙、磷、碱性磷酸酶活性检测。     

An outbreak of adenovirus type 7 infection in children in Montreal

Thirteen infants and children with adenovirus type 7 infection proved by virus isolation are described. High fever, cough and dyspnea were the most frequent findings; in infants under 1 year of age wheezing was common. Four patients required artificial ventilation. Lobar collapse, consolidation and hyperinflation were frequent radiologic findings. None of the symptoms responded to antibiotic therapy or bronchodilator drugs. Three patients died (mortality rate of 23%). Pathologic findings were compatible with adenovirus type 7 pneumonia, and were characterized by a necrotizing bronchitis and bronchiolitis, patchy alveolar fibrinopurulent exudate and hyaline membrane formation. Some intra-alveolar epithelial cells showed strikingly abnormal nuclei and rare typical halo-outlined intranuclear inclusions were seen. Only one of eight survivors had evidence of significant chronic chest disease.     

Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities

OBJECTIVES: To describe the short-term outcomes in Aboriginal children admitted to hospital with radiological alveolar lobar changes; and determine whether predischarge chest radiography can predict respiratory morbidity found at follow-up. DESIGN, PARTICIPANTS, SETTING: Prospective cohort study of Aboriginal children admitted to Alice Springs Hospital between October 2000 and April 2001 with alveolar lobar abnormalities (area of consolidation, > or = 1 cm) on chest radiographs. Participants were to have a predischarge radiograph and be followed up for 12 months. MAIN OUTCOME MEASURES: Comorbidities, follow-up rate, and new respiratory disease found at follow-up. RESULTS: Of 113 children hospitalised with radiological alveolar lobar changes, 109 were Aboriginal. Their median age was 1.8 years (range, 0.2 months-13.3 years), and 124 episodes were recorded. Comorbidities were common in these children (anaemia, 51.5%; suppurative otitis media, 37.3%). The follow-up rate one year after admission was 83.1% of episodes. New treatable chronic respiratory morbidity was found in 20 (25.6%) of the 78 children with completed follow-up. Predischarge chest radiographs were predictive of all chronic respiratory morbidity when they showed no or minimal resolution (0-20% resolution) (relative risk, 7.43; 95% CI, 2.07-26.60). CONCLUSIONS: Central Australian Aboriginal children admitted to hospital with alveolar changes on chest radiographs have a substantial burden of chronic respiratory illness, and should be clinically followed up for early detection and management of chronic respiratory morbidity. A predischarge radiograph is useful, and patients whose radiograph shows no or minimal resolution should have a follow-up x-ray film.     

小儿肺炎衣原体肺炎38例临床分析

目的：探讨小儿肺炎衣原体肺炎的临床特点,提高对肺炎衣原体（CP）肺炎的认识。方法：采用酶联免疫吸附试验（ELISA）法检测患儿血清肺炎衣原体抗体IgM,对肺炎衣原体肺炎的临床特点进行分析。结果：38例肺炎衣原体肺炎均有咳嗽、发热28例（73.6%）,12例合并喘息发作（31.6%）,X线胸片有不同程度的肺炎表现,心肌酶增高10例,GOT、GPT增高7例（18.4%）。结论：CP是小儿呼吸道感染的重要病原体之一,临床上以咳嗽为突出表现,可伴有发热、喘息等表现,在引起呼吸道感染的同时还可伴有多种肺外表现。     

使用GBZ70-2002标准诊断尘肺病185例分析

目的总结使用GBZ70-2002标准诊断尘肺病的体会。方法回顾性分析1150人的体检资料,全部受检者均摄有符合标准的高仟伏胸片,其中5例还进行了CT平扫,依据GBZ70-2002为标准,对照标准片实行集体诊断。结果总共诊断出尘肺病185例,其中Ⅰ期125例,Ⅱ期51例,Ⅲ期9例。另有42例诊断为0+。结论严格执行标准,拍摄符合标准技术要求的胸片,参照标准准片实行集体诊断的原则,是准确诊断坐肺病的关键。鉴别诊断时结合CT/HRCT,MRI或其它检查是有帮助的。     

婴幼儿社区获得性肺炎支原体肺炎58例临床特点分析

目的:探讨婴幼儿社区获得性肺炎支原体肺炎的临床特点。方法:总结分析58例婴幼儿社区获得性肺炎支原体肺炎的临床表现、胸部X线特点、血像、MP-IgM抗体检测、治疗等临床资料。结果:婴幼儿肺炎支原体肺炎(MPP)起病急,表现为发热、刺激性干咳,大部分病例出现喘息(65%),且大多为第一次喘息发作(75%);肺部体征明显,表现为湿啰音、喘鸣音;本组资料显示MPP肺外表现主要为呕吐、腹泻等消化系统症状;胸部X线病变类型以肺间质浸润为主,58%病例双肺受累,单侧病变大多累及右中下肺(24%),多数病例外周血白细胞总数正常(60%);本组40%的病例病初1周内检测血清MP-IgM水平不高,需要进行双份血清抗体检测来诊断。所有病例均使用阿奇霉素治疗,采用序贯疗法,总疗程不少于3周;经治疗,所有病例均临床治愈,MP感染全年均有散发,好发于冬春季。结论:肺炎支原体已成为婴幼儿社区获得性肺炎的重要致病原,对于3岁以下首次喘息发作的患儿或反复喘息发作的患儿,要充分考虑肺炎支原体感染的可能,要尽早明确诊断,及早规范治疗,防止其发展为哮喘。     

无痛纤维支气管镜检术在小儿肺部疾病诊断与治疗中的应用

目的：总结无痛纤维支气管镜检术在小儿肺部疾病诊断与治疗中的应用;方法：在麻醉科医生使用异丙酚基础麻醉下,应用Olympus BF3c-20纤维支气管镜对45例肺炎合并肺不张、慢性咳嗽、难治性喘息的患儿进行纤维支气管镜检查治疗.结果：45例中男性26例,女性19例,年龄在4个月至13岁.其中17例肺不张,纤维支气管镜下大多表现为支气管粘膜充血、水肿,病变支气管炎性狭窄,粘稠分泌物阻塞,灌洗后10例复张.7例难治性喘息病例中,4例镜下证实为支气管异物,3例存在气管-支气管软化和支气管开口异常.结论：无痛纤维支气管镜检术减少或避免了因患儿不合作造成气道远端损伤的风险,对复杂的病例观察更为细致,解决了患儿的不合作,增加了安全性.     

Does This Infant Have Pneumonia?

Peter Margolis, MD, PhD; Anne Gadomski, MD, MPH

JAMA. 1998;279:308-313.

Acute lower respiratory tract illness is common among children seen in primary care. We reviewed the accuracy and precision of the clinical examination in detecting pneumonia in children. Although most cases are viral, it is important to identify bacterial pneumonia to provide appropriate therapy. Studies were identified by searching MEDLINE from 1982 to 1995, reviewing reference lists, reviewing a published compendium of studies of the clinical examination, and consulting experts. Observer agreement is good for most signs on the clinical examination. Each study was reviewed by 2 observers and graded for methodologic quality. There is better agreement about signs that can be observed (eg, use of accessory muscles, color, attentiveness; , 0.48-0.66) than signs that require auscultation of the chest (eg, adventitious sounds; , 0.3). Measurements of the respiratory rate are enhanced by counting for 60 seconds. The best individual finding for ruling out pneumonia is the absence of tachypnea. Chest indrawing, and other signs of increased work of breathing, increases the likelihood of pneumonia. If all clinical signs (respiratory rate, auscultation, and work of breathing) are negative, the chest x-ray findings are unlikely to be positive. Studies are needed to assess the value of clinical findings when they are used together.

     

The diagnostic value of various features for acute lower respiratory infection among under fives

One hundred and fifty children aged between 5 months and 5 years with cough of less than 2 weeks duration, and presenting at the paediatric filter clinic and paediatric observation ward of the Kenyatta National Hospital between July and December 1985 were each evaluated by a complete history, physical examination, and a chest X-ray. Ninety of them (or 60%) had radiological evidence of pneumonia. Respiratory rate of over 50 per minute, chest indrawing, flaring of alae nasae, and a history of rapid breathing were found to be valuable indicators of pneumonia.     

儿科急诊抢救中存在的问题及处理方法

目的总结和分析儿科急诊抢救中存在的问题,并提出相应对策,以降低患儿的死亡率。方法对2001年1月～2011年12月我院儿科急诊收治的10 324例危重儿进行临床分析。结果急性上呼吸道感染、急性胃肠炎、急性支气管炎肺炎分别位列儿科急诊疾病病因的前三位。结论重视对危重患儿的识别并做进一步检查评估是降低危重儿病死率的关键;预防和早期干预器官功能衰竭是抢救重点;积极纠正危重儿的水电解质紊乱,提高患儿的生存率。     

小儿肺炎支原体肺炎40例临床分析

目的 :探讨小儿肺炎支原体肺炎的临床表现、X线表现、诊断治疗及预后转归。方法 :回顾分析 40例小儿肺炎支原体肺炎的临床及 X线表现、诊断及治疗转归。结果 :3月至 1岁发病例数占 1 7.5 % ;1～ 3岁占 37.5 % ;4～ 7岁占 2 5 % ;8～ 1 5岁占 2 0 %。咳嗽占1 0 0 % ;发热占 82 .5 % ;77.5 %有肺部体征。肺部 X线表现为以右肺病变为主的肺门影增大、肺纹理增粗、小片状及云絮状密度增高影 ;1 5 %病例呈节段性或大叶性高密度影。结论 :小儿肺炎支原体肺炎高发于幼儿、学龄前儿童 ,1 0 %病例有并发症。早期应用红霉素治疗效果显著 ,总疗程 3～ 6周     

支气管镜联合肺泡灌洗液在反复喘息患儿中诊断价值研究

探究支气管镜联合肺泡灌洗液在反复喘息患儿中诊断价值。选取2015年7月至2017年7月期间本院收录的反复喘息患儿343例,对于1岁以下反复喘息的婴幼儿采用检测CMV-DNA和MP-DNA在患者体内的水平;1岁以上儿童则采用检测MP-DNA的方式确定儿童患病原因。标本检出致病菌158株,阳性率(70.5%),其中革兰阴性菌111株(占阳性标本的70.3%),革兰阳性菌41株,真菌6株。单独检测患儿CMV-DNA的阳性率为61.8%,单独肺泡灌洗液支原体检测的阳性率为56.8%,实验组组间的比较差异无统计学意义(P＞0.05);支气管镜联合肺泡灌洗液检测支原体及CMV-DNA的阳性率为77.1%,与单独检测组有显著性差异(P＜0.05)。支气管镜联合肺泡灌洗液的方法能显著提高儿童反复喘息的诊断精确率,为精确治疗提供依据。     

小儿支原体肺炎185例临床特点分析

目的探讨与分析小儿支原体肺炎的临床特点。方法对2010年1月—2011年1月期间来我院就诊的185例支原体肺炎患儿的临床资料进行回顾性分析。结果 0～3岁患儿支原体肺炎的发病率相对较高,临床表现以喘息、干湿啰音多见,发热不明显,肺外表现不明显,肺部阳性体征明显,胸片表现以小斑片状阴影多见。7～14岁患儿支原体肺炎的临床表现以发热多见,肺外表现明显,胸片表现以大片状阴影多见。4～6岁患儿支原体肺炎的临床资料则居中。结论不同年龄段的小儿支原体肺炎有不同的临床特点。     

呼吸道病毒特异性IgM抗体检测在儿童ALRI诊断中的临床应用价值

目的：探讨本地区急性下呼吸道感染（ALRI）的流行病学特点,并研究呼吸道病毒特异性免疫球蛋M（IgM）抗体检测在儿童ALRI诊断中的临床应用价值。方法：选择我院646例儿童ALRI为研究对象,回顾性分析呼吸道病毒特异性IgM抗体的检测情况。结果：646例ALRI患儿腺病毒（ADV）、呼吸道合胞病毒（RSV）、柯萨奇病毒（CBV）、甲型流感病毒（IFVA）、乙型流感病毒（IFVB）及副流感病毒1,2,3型（PIV1、PIV2、PIV3）检测单一病毒感染率46.0%,复合感染率11.8%,其中以RSV 20.0%、ADV 10.1%、PIV 38.8%、IFVA 8.5%感染率较高;4种主要病毒IgM抗体检测阳性率年龄分布以6个月～1岁（81.3%）、1～3岁（45.7%）较高;季节分布RSV、IFVA、PIV3以冬春季高发;在不同临床诊断中ADV引起的支气管炎较为多见,IFVA、PIV3以支气管炎、支气管肺炎多见。结论：呼吸道病毒特异性IgM抗体检测在儿童ALRI诊断中有重要的临床应用价值。     

Ultrastructural changes in animal fat associated lipoid pneumonia: report of two cases

Traditional or cultural practices in different parts of the world where oils are used continue to produce lipoid pneumonia. We report the ultrastructural findings and observations in animal fat associated lipoid pneumonia from two children following a cultural practice of forced feeding with animal fat (ghee). Clinical findings showed an acute or chronic chest infection which failed to respond to anti-microbial therapy. X-ray and chest CT scan revealed collapse/consolidations of the right middle and left lower lobes. Histology and electron microscopy revealed thickening and destruction of the alveolar septa, filling of alveolar spaces with red blood cells and macrophage which contained both primary and secondary lysosomes. The alveolar walls contained mostly type II pneumocyte with most of them surrounded by thickened basement membranes with only a small portion of their surfaces exposed directly to the alveolar space where it showed numerous microvilli.     

多层螺旋CT平扫加三维重建在反复或持续喘息患儿中的应用

目的 探讨多层螺旋CT平扫加三维重建在反复或持续咳喘患儿中的临床应用价值.方法 对临床以持续喘息≥4周或反复喘息≥3次的80 例住院患儿进行胸部多层螺旋CT平扫加三维重建检查.结果 80 例患儿中支气管异物16 例,经耳鼻喉科会诊取出异物后咳喘症状消失;支气管发育异常10 例与支气管镜检查符合;肺炎54 例,经加强抗感染治疗后好转,其中5例行支气管镜灌洗后痊愈.结论 胸部多层螺旋CT平扫加三维重建能准确诊断气管支气管异物、明确异物位置、判断气管先天畸形;了解肺部炎症程度及痰栓堵塞位置,为指导进一步治疗提供重要依据.     

35例坠积性肺炎的胸部X线平片与CT诊断价值分析

目的探讨重症患者并发坠积性肺炎的胸部X线、CT（计算机X线体层摄影）影像表现,并分析其诊断价值。方法对我院2009年7月至2010年10月在我院住院治疗的35例重症患者并发坠积性肺炎的胸部X线、CT检查及临床资料进行回顾性分析。结果 35例重症患者CT诊断并发两下肺坠积性肺炎24例,并发单侧下肺坠积性肺炎11例。33例胸腔出现胸水或胸膜反应。X线诊断11例并发两下肺炎,8例并发单侧肺炎,4例诊断胸腔积液,5例提示可疑肺部或胸膜病变,7例未见异常改变。结论坠积性肺炎是重症患者的严重并发症之一,胸部X线检查有一定局限性,常出现假阴性,易漏诊,但简便易行,是急查及治疗后复查的首选检查方法;CT检查无解剖结构重叠,分辨率高,能明确病变的程度、范围,诊断准确,无假阴性出现,是病情允许下的首选检查方法。     

COVID-19流行期间综合性儿童医院门急诊及住院病房的护理管理策略

从2020年1月以来复旦大学附属儿科医院作为上海市儿童COVID-19感染者收治的定点医院,儿科护理团队在疫情发生初始进行了快速反应,建立了从门急诊到住院病房护理管理流程,本文详细解读了患儿从门急诊预检、留观、住院、检查到出院的每个环节需进行的护理管理和防护要求,为广大儿科护理工作者在疫情期间的工作提供切实可行的借鉴。