儿童支原体肺炎的纤维支气管镜诊治研究

目的探讨支原体肺炎在纤维支气管镜镜下形态学表现特点及介入治疗支原体肺炎的效果。 方法收集1996-01—2006-06在北京儿童医院就诊的住院患儿170例，临床确诊为支原体肺炎，经纤维支气管镜检查并予以病变局部介入治疗。 结果所有患儿在纤维支气管镜下均可见黏膜粗糙、肿胀、分泌物附着，部分患儿有血管走行粗重(117例，68.8%)，纵行皱褶(65例，38.2%)，黏 膜花斑样改变(24例，14.1%)，黏膜腺体小结样突起(19例，11.2%)，黏膜糜烂(5例，2.9%)；管腔开口炎性狭窄(94例，55.3%)，甚至闭塞(27例 ，15.9%)，段支气管通气不畅(120例，70.6%);管腔分泌物多数呈半透明或灰白黏稠状，部分形成黏液栓阻塞细支气管(46例，27.1%)。经过治 疗，所有病例均有改善，141例(82.9%)患儿介入治疗1~4次，最多10次。 结论支原体肺炎可并发肺不张;纤维支气管镜下主要特点为支气管黏膜病变和黏液栓阻塞，管腔开口炎性狭窄、闭塞，段支气管通气不畅;早期 经纤维支气管镜诊治有利于缩短病程。     

儿童腺病毒肺炎临床特征分析

目的通过对儿童腺病毒性肺炎的临床特征分析,进而提高对该疾病诊治的认识。方法分析39例腺病毒肺炎患儿的临床资料,对其临床表现、影像学改变及治疗转归进行总结。结果在39例患儿中,32例持续高热、咳嗽、有细湿啰音、伴有持续喘鸣,合并心力衰竭4例,低氧血症10例,呼吸衰竭8例,中毒性心肌炎10例。X线和CT显示大片影9例,小片融合灶10例,薄片影12例,肺气肿6例,两肺间质性改变8例,伴胸腔少量积液3例。其中9例行纤维支气管镜检查提示支气管内膜炎症明显,2例伴黏膜糜烂,1例有较多黏液。其中32例治疗中使用激素及静脉丙种球蛋白。6例随访患儿出现闭塞性细支气管炎表现,其中1例合并支气管扩张。结论儿童腺病毒肺炎病情重、合并症发生率高,易遗留后遗症。     

82例儿童重症肺炎支原体肺炎行支气管镜介入治疗的护理

目的观察儿童重症肺炎支原体肺炎行纤维支气管镜介入治疗的护理方法。方法 82例重症肺炎支原体肺炎患儿行支气管镜介入治疗,在常规护理基础上给予患儿术前、术后预见性护理干预。结果82例患儿均无严重并发症发生,术前患儿的依从性100%。结论预见性护理干预是保证支气管镜介入治疗成功的有效措施。     

小儿肺炎支原体肺炎168例临床特点回顾性分析

目的总结小儿肺炎支原体肺炎的临床特点,并评价其疗效。方法回顾性分析168例小儿肺炎支原体肺炎的临床特点、影像学表现、血清学抗体检测及治疗与转归。结果本病以冬、春季发病率高,发病年龄≤3岁49例（29.00%）,4~7岁70例（42.00%）,8~14岁49例（29.00%）。98%患儿有发热,所有患儿均有咳嗽。胸片X线及胸部CT检查以斑片状病灶及大片状病灶为主,可为单侧或双侧,大片状肺实质性病变及肺叶实质性病变占72.00%（121例）。血清学检测肺炎支原体抗体全部阳性。所有病例均使用阿奇霉素静脉缓慢输注2~3个疗程,后改为口服罗红霉素分散片或阿奇霉素片巩固治疗。4周后复查肺炎支原体抗体阴性。随访3个月160例（95.00%）患儿肺部病灶完全吸收。结论小儿肺炎支原体肺炎高发于学龄前儿童,病灶以大片状病灶及肺实质性病变居多。大环内酯类类抗生素效果佳,但疗程较长,远期随访效果理想。     

支气管镜检查术用于反复咳喘疾病的诊治作用分析

摘要：目的　探讨支气管镜检查术在反复咳喘疾病诊治中的作用。 方法　对首都儿科研究所2005年9月至2008年3月诊治的244例反复咳嗽、喘息，病程在1个月以上患儿行支气管镜检查及治疗的临床资料进行综合分析。结果　149例“咳喘原因待查”患儿支气管镜检查镜下最常见病因为感染，其中支气管炎88例，支气管开口水肿、炎性狭窄6例，痰液阻塞6例；镜检第二位病因为先天气道畸型（22例），占14.8%；镜检第三位病因为气道异物（21例），占14.1%。46例肺炎、肺不张患儿支气管镜检查结果提示感染引起的支气管开口阻塞仍然是小儿肺炎、肺不张迁延不愈的主要原因，占87%，通过支气管镜灌洗、钳夹治疗后多数患儿炎症吸收，肺不张消失。49例临床确诊为“儿童哮喘”患儿大多数镜下表现为支气管炎，占85.7％。结论　支气管镜检查术可以为临床反复咳喘患儿诊治提供很大帮助。     

肺炎支原体肺炎伴中枢神经系统损害45例临床特点分析

目的总结肺炎支原体肺炎患儿伴中枢神经系统损害的临床特点。方法分析45例肺炎支原体肺炎伴中枢神经系统损害患儿的临床资料。结果45例患儿均有发热。主要表现有惊厥、头痛、呕吐、意识障碍等,除综合治疗外,给予红霉素或阿奇霉素及糖皮质激素治疗有效。结论中枢神经系统损害是肺炎支原体肺外感染最严重的并发症,应尽早确诊,及时给予红霉素或阿奇霉素及糖皮质激素治疗,可迅速改善中毒症状,能有效降低死亡率,减少后遗症的发生。     

小儿肺炎支原体肺炎120例回顾性分析

目的 总结小儿支原体肺炎的临床特点并观察疗效.方法 采用回顾性分析方法,总结120例支原体肺炎的临床表现特点、实验室检查、X线表现、支气管镜、肺功能检测特点及应用大环内酯类药物治疗的效果.结果 支原体肺炎表现为发热,阵发性连续性咳嗽;肺部体征出现较晚,X线表现为单侧病变多于双侧,不完全节段性或大叶实变及斑片状密度增高影...     

X线胸片呈大叶性肺炎改变的儿童肺炎支原体肺炎409例临床分析

探讨X线胸片呈大叶性肺炎改变的儿童肺炎支原体肺炎（MPP）的临床特点及诊疗转归。方法　2005年1月至2009年8月于吉林大学第一医院就诊的409例X线胸片呈大叶性肺炎改变、血肺炎支原体抗体（MP-IgM）阳性的MPP患儿,对其临床资料进行回顾性分析。结果　409例中学龄期以上发病223例（54.5%）,婴幼儿期发病95例（23.2%）。病程长,以发热（88.3%）为主要表现, 胸片检查中359例（87.8%）单侧病变,225例（55.1%）合并肺外并发症,325例（79.4％）的患儿外周血常规中白细胞计数高于正常,中性粒细胞比例 > 0.80 259例（63.3%）,单核细胞比例 > 0.08 317例（77.5%）,324例（83.7%）患儿超敏C反应蛋白（CRP）高于正常;体液培养共培养出阳性菌株162例,最常见的合并细菌感染种类为金黄色葡萄球菌及肺炎链球菌。合并细菌感染者单纯应用大环内酯类药物治疗效果欠佳,联合青霉素类或头孢类抗生素治疗后见效明显。 结论　临床需注意MPP胸片改变的多样性, 对于胸片呈大叶性改变、单纯应用大环内酯类抗生素治疗效果欠佳的MPP患儿,应高度警惕合并细菌感染,及时行相关病原学检查,联合用药效果较好。     

拔罐走罐辅助治疗婴幼儿支气管肺炎36例疗效观察

目的观察拔罐走罐辅助治疗婴幼儿支气管肺炎难消性湿啰音的疗效？椒ā〗？2例肺部难消性湿啰音的支气管肺炎患儿随机分成观察组和对照组各36例。两组患儿治疗初期均给予敏感抗生素,辅以中药免煎剂治疗,观察组在此基础上辅助拔罐走罐疗法,隔日1次,疗程6d。观察两组治疗后症状、体征改善程度。结果观察组治愈率72.2%（26/36）,明显高于对照组27.8%（10/36）,差异有统计学意义（P〈0.01）。结论拔罐走罐辅助治疗婴幼儿肺部难消性湿啰音疗效显著。     

雾化吸入普米克令舒佐治肺炎支原体肺炎46例疗效观察

目的观察普米克令舒佐治儿童肺炎支原体肺炎临床效果。方法将92例肺炎支原体肺炎患儿按住院单双号分为观察组和对照组,对照组患儿经综合治疗及阿奇霉素抗炎治疗,观察组在对照组治疗的基础上加普米克令舒雾化吸入,每日2次,每次10～15min,疗程3～5d。疗程结束后比较两组患儿的治疗效果,观察发热、咳嗽等体征消失时间及住院时间。结果观察组总有效率89.1%（42/46）,明显高于对照组73.9%（34/46）,差异有统计学意义（P〈0.05）。观察组体征消失及住院时间均短于对照组,差异有统计学意义（P〈0.05）。结论雾化吸入普米克令舒治疗儿童肺炎支原体肺炎临床效果好,疗效快,值得推广。     

39例儿童重症肺炎支原体肺炎临床特征及糖皮质激素疗效分析

目的分析儿童重症肺炎支原体肺炎临床特征及观察糖皮质激素的疗效。方法对2013年7月至12月在沈阳市儿童医院诊治的39例重症肺炎支原体肺炎患儿资料进行临床特征,分为激素组及对照组。比较两组热退时间,痉咳时间及住院时间。结果 39例患儿均有发热,咳嗽症状,病程5~10d。白细胞计数29例增高。影像检查均发现大片状密度增高影或肺实质浸润性病变,其中双肺片状影5例,单侧34例。MP-IgM抗体≥160。8例出现胸腔积液,2例出现肺不张,6例出现肝功异常,5例出现心肌酶谱异常,2例出现皮疹。激素组发热时间和痉咳时间分别是(6.7±1.3)d和(5.35±1.62)d,明显短于对照组(8.3±1.4)d和(7.27±1.58)d,两组比较差异均有统计学意义(P0.05);激素组住院时间为(14.8±6.2)d,对照组为(12.8±3.3)d,两组比较差异无统计学意义(P0.05)。结论儿童重症肺炎支原体肺炎可引肺内严重感染及肺外多种并发症,早期应用糖皮质激素治疗,可取得良好效果。     

Comparison of the clinical manifestations of severe acute respiratory syndrome and Mycoplasma pneumoniae pneumonia.

BACKGROUND AND PURPOSE: The clinical manifestations of severe acute respiratory syndrome (SARS) and mycoplasma pneumonia are similar. However, administration of corticosteroid to Mycoplasma pneumoniae patients suspected of having SARS may unnecessarily increase the risk of opportunistic infection. We compared the clinical course of 13 SARS patients and 6 patients with mycoplasma pneumonia treated during the outbreak of SARS in Taiwan. METHODS: Patients admitted due to suspicion of SARS with a subsequent diagnosis of SARS or Mycoplasma pneumoniae pneumonia were included. RESULTS: The initial clinical manifestations were similar in patients with SARS and those with M. pneumoniae infection. However, SARS patients had more severe lymphopenia (p = 0.013) and anemia (p = 0.007), and more persistent pulmonary infiltrates (p = 0.023). Respiratory failure developed in 15.4% of the SARS patients and in none of the M. pneumoniae patients. Recovery from thrombocytopenia was associated with defervescence in 12 SARS patients and radiographic improvement in 6 in the following 5 days. In those with unsatisfactory resolution of the pulmonary infiltrates, corticosteroid therapy was associated with rapid radiographic improvement. CONCLUSIONS: Because of similar initial presentations, differentiating SARS from M. pneumoniae pneumonia is very difficult based on symptomatology. In this series, lymphopenia and anemia were more severe in SARS than in M. pneumoniae infection, and SARS patients had more persistent and more new pulmonary infiltrates after hospitalization.     

小儿特发性间质性肺炎18例临床分析

摘要：目的　探讨儿童特发性间质性肺炎（IIP）的病因、临床特点、疗效及随访结果。方法　采用临床流行病学调查方法,对2003年7月至2008年7月于新疆医科大学第一附属医院儿科临床诊断为IIP的18例患儿资料进行分析。将其中部分血清学检测指标与同期来院体检35名儿童（对照组）的血样本资料进行比较。结果　18例均未查明与患病有直接关系的确切病因,仅发现与发病有关的背景因素;患儿呈现进行性呼吸困难而致活动受限,干咳、气短,多无发热,有消瘦或体重下降、乏力、纳差,双肺底部可闻及细小湿性啰音（Velcro啰音）,伴有不同程度的紫绀、杵状指为其主要表现;入院前多被诊断为支气管肺炎、哮喘或肺结核等;与对照组相比,多数患儿有血白细胞和乳酸脱氢酶（LDH）、C-反应蛋白（CRP）升高,血沉（ESR）增快,血清肿瘤坏死因子-α（TNF-α）、白介素-8（IL-8）异常,α-抗胰蛋白酶（α-AT）减低等特点,胸片表现双肺广泛浸润性改变,（HRCT）以双下肺叶弥漫性网状、蜂窝样、磨玻璃状改变为主,肺功能（＞8岁）为限制性通气障碍,血气分析和心电监护仪显示持续性低氧血症;给予糖皮质激素冲击联合丙种球蛋白静滴,阿奇霉素口服、糖皮质激素吸入等治疗及随访,症状缓解12例,死亡3例,无效自动出院失访3例。结论　IIP病因多不明确,病程迁延而危重,症状多持续或反复,易于误诊或漏诊,依据临床表现和实验室以及必要的影像学检查是早期诊断关键,尽管治疗比较困难,综合治疗仍能使部分患儿症状得到控制,肺组织活检在儿科实施尚有难度。     

不同机械通气方式治疗胎粪吸入综合征的随机对照研究

目的　比较不同机械通气方式对胎粪吸入综合征（MAS）患儿的治疗作用及并发症的发生。方法　河北省儿童医院新生儿科重症监护室2006年7月至2008年7月收治的84例氧合指数（OI） ≥ 15的重症胎粪吸入综合征患儿随机分为3组：A组25例患儿采用高频振荡 （HFOV）模式治疗;B组29例患儿采用同步间歇正压联合容量保证 （SIPPV+VG）模式治疗;C组30例采用间歇指令通气（IMV）模式治疗。比较3组治疗前后各时间点OI、动脉/肺泡氧分压比值（a/APO2）的变化,并对3组患儿的氧暴露时间、机械通气时间,以及肺气漏、呼吸机相关性肺炎、Ⅲ度以上颅内出血等并发症的发生率进行比较。结果　A组与B组在机械通气24 h后OI和a/APO2值均与0 h差异有统计学意义（P < 0.05）,而C组直到72 h方与0 h时差异有统计学意义（P < 0.05）。A组与B组各时间点相比差异均无统计学意义。A组与B组相比,氧暴露时间和上呼吸机时间均无统计学差异（P > 0.05）,但是A组与C组、B组与C组相比在统计学上差异均有统计学意义（P < 0.05）。不仅如此,A组与C组、B组与C组相比,肺气漏与呼吸机相关性肺炎的发生率差异均有统计学意义（P < 0.05）。Ⅲ度以上颅内出血的发生率3组相比差异无统计学意义（P > 0.05）。结论 　HFOV、SIPPV+VG通气模式与IMV比较,可以较快改善MAS的氧合,缩短氧暴露时间和呼吸机使用时间,降低肺气漏和呼吸机相关性肺炎的发生,可作为更有效、更安全的抢救性治疗手段。     

Mycoplasma pneumoniae in women

Mycoplasma pneumoniae (primary atypical or Eatons’ agent) is a common cause of walking or atypical pneumonia in young adults. It is responsible for approximately 43% of the cases of community-acquired pneumonia in patients between the ages of 17 and 44. Patients with Mycoplasma pneumonia typically present with the gradual onset of a nonproductive cough, sore throat, fever, and pulmonary infiltrates on chest x-ray. The diagnosis is based on symptomatology and on radiographic findings such as interstitial infiltrates, patchy infiltrates, plate-like atelectasis, nodular infiltration, or hilar adenopathy. The primary treatment for Mycoplasma pneumoniae is a macrolide antibiotic, preferably azithromycin: 500 mg initially and then 250 mg daily for 4 days.     

儿童支原体肺炎70例临床诊治分析

目的:探讨儿童支原体肺炎的临床表现度诊断治疗方法。方法:回顾性分析70例肺炎支原体肺炎患儿的临床资料。结果:发热、咳嗽是肺炎支原体肺炎患儿主要症状;婴幼儿伴发喘息的较多;影像学检查以肺内单侧斑片状阴影为多见;阿奇霉素及红霉素治疗有效。结论:支原体肺炎发病率较高,早期症状较重,体征较轻,胸部X线阴影明显。大环内酯类抗生素治疗有效,尤其是阿奇霉素,安全、效好。     

机械通气联合肺表面活性物质治疗重症新生儿呼吸窘迫综合征168例临床分析

归纳新生儿呼吸窘迫综合征（RDS）的临床特点,观察肺表面活性物质（PS）在机械通气治疗新生儿RDS中的作用。方法　收集2006年9月至2008年2月在河北省儿童医院新生儿科住院治疗的168例RDS患儿临床资料,平均胎龄为（32.3±3.7）周,平均体重为（1.73±0.75）g。观察比较国产PS（珂立苏,calsurf）应用前后的主要血气指标、呼吸机参数、机械通气模式以及并发症、转归等。结果　应用PS在0、1、12和72 h不同时点的比较显示：吸氧浓度（FiO2）分别为0.51±0.11、0.32±0.1、0.28±0.08 和 0.26±0.09。应用PS 1h时,RDS患儿所需FiO2明显下降,此后下降幅度逐渐减小（P < 0.05）。动脉血氧分压PaO2 /吸入氧浓度FiO2（P/F）和动脉血氧分压/肺泡氧分压a/APO2比值则随时间变化呈逐渐增高趋势,但差异无统计学意义（P > 0.05）。结论　PS能较快地改善新生儿RDS氧合状况;肺保护性通气策略正在为越来越多的临床医生接受。     

Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study

OBJECTIVE: To assess the pulmonary manifestations of severe ovarian hyperstimulation syndrome (OHSS). DESIGN: A retrospective nationwide 10-year multicenter study. SETTING: Sixteen of 19 tertiary medical centers in Israel. PATIENT(S): All patients hospitalized at these centers for severe OHSS between January 1987 and December 1996. MAIN OUTCOME MEASURE(S): Clinical presentation, arterial blood gases on room air, and chest roentgenogram results. RESULT(S): Of 209 patients, 4% had lobar pneumonia, 2% had adult respiratory distress syndrome (ARDS), and 2% had pulmonary thromboembolism. Most patients had dyspnea, tachypnea, moderate hypoxemia, increased alveolar-arterial oxygen difference, hypocarbia, respiratory alkalosis, and metabolic compensation. The most common findings on chest roentgenogram were bilateral elevation of the diaphragm, pleural effusion, and pulmonary atelectasis. Patients with pulmonary thromboembolism, ARDS, and pneumonia presented with severe hypoxemia and alveolar-arterial oxygen difference and distinct radiographic findings. CONCLUSION(S): Severe OHSS is characterized by an extraparenchymal restrictive type of pulmonary dysfunction, attributed to intraabdominal or pleural fluid accumulation, which limits descent of the diaphragm and expansion of the thoracic cage. This may induce uncoordinated lung ventilation and atelectasis with subsequent ventilation-perfusion mismatch and hypoxemia. The clinical picture may deteriorate further because of pulmonary infection, pulmonary thromboembolism, or ARDS, all of which have distinct clinical, radiographic, and blood gas characteristics.     

Selective bronchial intubation in infants with lobar emphysema: indications, complications, and long-term outcome

Thirteen infants underwent selective intubation of a mainstem bronchus (SBI) for lobar emphysema of varying etiologies. Seven infants had pulmonary interstitial emphysema (PIE) with lobar hyperinflation secondary to hyaline membrane disease and mechanical ventilation. Six of these improved with SBI and five maintained permanent resolution upon cessation of SBI. Two infants with localized areas of emphysema who were subsequently shown to have histologic evidence of bronchopulmonary dysplasia had unsuccessful SBI. SBI was also unsuccessful in permanently resolving congenital lobar emphysema although temporary collapse of the affected lobe occurred during SBI. Complications including hypoxia, bradycardia, right upper lobe atelectasis, pneumonia, and additional air leaks occurred during SBI in six cases. Follow-up xenon ventilation scans in four infants in whom SBI was successful revealed normal ventilation of the previously diseased lobes. SBI can be a useful alternative to surgical excision of the affected lobe in patients with localized lobar hyperinflation secondary to PIE. SBI is generally unsuccessful in permanently correcting congenital lobar emphysema, nor should it be used when chronic diffuse parenchymal damage is present.