Nutrition therapy in critically ill infants and children

Infants and children are susceptible to the profound metabolic effects of critical illness. In addition, preexisting malnutrition and obesity have adverse consequences during the intensive care unit stay. Early enteral and parenteral feeding can improve nutrition deficits, but neither has been sufficiently studied to show an effect on clinical outcomes in pediatric critical care. Indirect calorimetry is a useful technique that identifies patients receiving inadequate or excessive nutrition, but this technique is underused.     

Pleural effusion and empyema as complications of pneumonia

Parapneumonic effusion is observed radiologically in approximately 40% of the patients with a bacterial pneumonia. In most cases the course of the disease is uncomplicated, and the parapneumonic effusion (PPE) resolves with antibiotic therapy. However, in 5-10% of the patients, PPE becomes more complicated (loculation) and the effusion eventually leads to the formation of an empyema if no drainage has been performed. In view of negative impact on morbidity and mortality, it is important to recognise and evaluate a PPE as soon as possible. Intrapleural pus is the only absolute indication for drainage. In all other cases, the risk of a complicated PPE has to be established in the early phase of the illness, based on radiological, biochemical and microbiological parameters of the effusion. Based on these findings one or more of the following therapeutic strategies can be chosen: tube installation with drainage, fibrinolytical therapy, video-assisted thoracoscopic surgery, thoracotomy with or without decortication, or open drainage. Although every PPE needs to be evaluated on an individual basis, an attempt has been made to formulate a strategy that can be used in clinical practice, based on recent literature and expert opinions.     

Pleural empyema in mechanically ventilated patients with pneumonia

Two males aged 41 and 32 years developed pneumonia which responded inadequately to antibiotic treatment and necessitated mechanical ventilation. It was only after surgical and digital opening, drainage of pus pockets and daily pleural lavage that the clinical picture improved. The microorganisms cultured from both patients included Streptococcus milleri, probably acquired by aspiration. Thoracic empyema as a complication of pneumonia is clinically recognised by lack of response to antimicrobial agents. For the diagnosis, ultrasonographic and CT imaging, followed by pleural puncture are used. Simple parapneumonic effusions are managed by drainage with or without rinsing with normal saline, while in advanced empyema, instillations with fibrinolytic agents have proved safe and effective. Sometimes, video-assisted thoracoscopic or conventional surgery is necessary to clear the pleural space, while in complicated cases, extensive surgical procedures are warranted.     

儿童肺炎支原体肺炎合并胸腔积液临床表现及危险因素分析

目的探究儿童肺炎支原体肺炎(MPP)合并胸腔积液(PE)的临床表现及实验室检测情况,为临床诊治提供依据。方法选取2019年4月1日至12月31日于西安市儿童医院呼吸一科确诊为MPP的137例患儿为研究对象,根据有无合并PE分为单纯MPP组67例及合并PE组70例,比较两组间临床表现、合并症、实验室检查的差异。结果合并PE组热峰、热程、住院时间及总病程均大于单纯MPP组(Z值分别为-3.948、-5.032、-4.268、-5.590,均P<0.05);合并PE组白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)水平均高于单纯MPP组(Z值分别为-3.133、-4.903、-3.853、-5.193,均P<0.05);合并PE组发生肝功能异常、低蛋白血症及心肌损害的比例均高于单纯MPP组(χ²值分别为196.300、23.739、10.880,均P<0.05);合并PE组较单纯MPP组的难治性肺炎支原体肺炎发病率更高,影像学以实变为主,均具有统计学意义(均P<0.05);多因素Logistic回归分析显示热峰>39.95℃、热程>11.5d、CRP>25.335mg/L及PCT>0.155ng/L是MPP合并胸腔积液的独立危险因素,其OR值及95%CI分别为3.577(1.046~12.238)、2.486(1.060~5.831)、3.755(1.570~8.983)、2.599(1.100~6.144),均P<0.05。结论MPP合并PE患儿机体内有过强的免疫炎症反应,需警惕难治性肺炎支原体肺炎可能;较高的热峰、CRP水平、PCT水平及较长的热程是MPP合并胸腔积液的独立危险因素。     

氨溴特罗口服液治疗婴幼儿支气管肺炎34例临床研究

目的通过研究和探讨氨溴特罗口服液治疗婴幼儿支气管肺炎的效果,总结经验,以更好地指导婴幼儿支气管肺炎的临床用药和治疗。方法随机选择我院最近一年中的68名婴幼儿支气管肺炎患者,将其平均分成A、B两组,A组为治疗组给予氨溴特罗口服液进行治疗;B组为对照组,给予盐酸氨溴索颗粒进行治疗。将两组治疗效果进行对比分析,并加以总结。结果经过治疗后,A组治疗组患者疗效明显高于B组对照组,有效率较高。结论氨溴特罗口服液对于治疗婴幼儿支气管炎具有较好的效果,疗效显著,具有较高的临床推广价值。     

小儿支原体肺炎合并胸腔积液体内D-二聚体、降钙素原、C-反应蛋白变化研究

目的 探讨D-二聚体(DD)、降钙素原(PCT) 及C-反应蛋白(CRP)水平在小儿支原体肺炎合并胸腔积液诊断及预后判断中的作用。方法 收集58例支原体肺炎合并胸腔积液患儿的临床资料,回顾性分析患儿的一般性特征,对发病期、恢复期及健康对照组进行DD 、PCT、CRP的检测,分析DD、PCT、CRP升高与患者发病期及预后的相关性对大量积液组、中量积液组、少量积液组患儿进行以及胸水常规化验指标分析比较。结果 发病期DD、PCT和CRP均高于恢复期、健康对照组(P均<0.01);恢复期DD高于对照组(P<0.01),PCT水平与对照组差异无统计学意义(P>0.05),CRP水平与对照组相比差异不大(P=0.015);发病期患儿体内DD、PCT及CRP升高的比例明显高于恢复期水平;发病期患儿大量积液组DD、PCT、CRP、有核细胞数、TP、LDH、ADA水平明显高于中等积液组、少量积液组;发病期CRP与DD、PCT升高呈正相关。结论 DD、PCT及CRP升高可以反映患儿支原体肺炎合并胸腔积液严重程度以及积液量;DD、PCT及CRP的变化趋势可以反映预后。     

6例难治性支原体肺炎的诊治体会

目的了解难治性支原体肺炎的临床特点，提高诊断与治疗水平。方法对6例难治性支原体肺炎患儿的临床资料进行回顾性分析。结果6例难治件支原体肺炎患儿中，急性期5例表现肺实变，3例表现肺实变合并大量胸腔积液，3例表现肺部病变进展迅速。6例难治性支原体肺炎患儿治疗除应用抗生素治疗外，加用糖皮质激素，疗效满意。恢复期有4例患儿肺部病变迁延不愈，需行纤维支气管镜灌洗。结论对于病情重、进展快、肺实变、中大量胸腔积液、炎性指标明显升高、单用大环内酯类抗生素治疗反应不佳及病变迁延不愈的支原体肺炎应高度考虑难治性支原体肺炎的可能性。一旦确诊，除抗生素治疗外，应积极早期应用糖皮质激素。对于病情稳定后仍有肺实变者，应尽早行纤维支气管灌洗。     

多巴胺、多巴酚丁胺辅助治疗婴幼儿重症肺炎的临床研究

目的探讨多巴胺、多巴酚丁胺辅助治疗婴幼儿重症肺炎的临床疗效。方法将126例重症肺炎婴幼儿随机分成治疗组和对照组,对照组按常规治疗,治疗组在常规治疗的同时,应用电脑微量注射泵控制小剂量多巴胺、多巴酚丁胺进行治疗。结果治疗组疗效优于对照组(P﹤0.01)。结论多巴胺、多巴酚丁胺治疗婴幼儿重症肺炎能促进病情好转,提高治愈率。     

婴幼儿与年长儿肺炎支原体肺炎的临床特征及对比分析

目的提高对婴幼儿与年长儿肺炎支原体肺炎的临床认识。方法回顾性分析310例肺炎支原体肺炎患儿临床表现及实验室检查、影像资料与年龄之间的关系。结果婴幼儿(0~3岁)以咳嗽及喘息为著,肺部罗音多见,发热不明显,胸部影像学以小叶性肺炎多见,并发症少,合并呼吸道病毒感染者较多;而年长儿(3岁)以发热及刺激性咳嗽为著,肺部体征不明显,易出现大叶性肺炎改变,易合并胸腔积液,肺不张,并发症多,合并EB病毒感染者较多。结论婴幼儿与年长儿肺炎支原体肺炎的临床特征有显著差异,根据其特点对诊治有所帮助。     

抗生素序贯疗法治疗儿童支气管肺炎60例临床分析

目的评价抗生素序贯疗法治疗小儿支气管肺炎的疗效及成本.方法将60例抗生素治疗有效的病例随机分为口服药物组20例,序贯疗法组20例,静脉注射组20例,根据疗效标准及治疗成本进行分析.结果静脉注射组总有效率95%,序贯疗法组总有效率95%,口服药物组总有效率90%,按疗效与成本综合分析,以序贯疗法组最佳.结论抗生素序贯疗法治疗小儿支气管肺炎有重要的临床应用价值.