婴幼儿肺炎潮气呼吸肺功能的检测及护理

肺功能是呼吸系统疾病重要的临床检测指标，对评估呼吸道疾病的严重程度、考核治疗效果有较高价值。但常规肺功能检测需要患者的主动配合，因而限制了其在儿科的应用，尤其是对婴幼儿的应用。而潮气呼吸肺功能检测解决了婴幼儿配合程度低的问题，只需在患儿平静睡眠时即可进行，故该检测方法适用于婴幼儿。目前国关于对婴幼儿肺炎潮气呼吸肺功能的研究较少。我科2005年1月-2006年5月共完成64例婴幼儿肺炎潮气呼吸肺功能检测，对协助临床诊断、指导治疗有重要意义，现报道如下。     

234例婴幼儿肺炎链球菌感染及药敏检测

目的分析婴幼儿肺炎链球菌感染及耐药情况.方法常规处理临床标本3 928例,采用生物梅里埃ATB自动细菌鉴定仪对分离纯化的肺炎链球菌做细菌鉴定和药敏试检测.结果 共分离出234例肺炎链球菌,其中痰标本中分离出224例,占总数92.3%(216/234),其他标本占7.7%.9例(3.8%)为青霉素耐药的肺炎链球菌(PRSP),对红霉素、克林霉素、四环素耐药率达90%以上,对万古霉素、左氧氟沙星100%敏感.结论 肺炎链球菌以感染婴幼儿呼吸道为主,对大环内酯类、四环素类耐药严重,而对喹诺酮类、头孢类敏感性高,提示第三代头孢可作为治疗小儿肺炎链球菌感染的首选药物.     

婴幼儿肺功能的检测与护理

目的 检测婴幼儿患呼吸系统疾患时肺功能状况，研究探讨2600型小儿肺功能仪操作方法，以协助临床诊断并指导治疗。方法 采用SensorMedics2600型小儿肺功能仪，对611例呼吸系统疾患婴幼儿进行睡眠时潮气呼吸流速容量（TBFV）环、被动呼气流速容量（PFV）曲线检查，部分患儿进行功能残气量（FRC）测定。结果 611例患儿中检出肺功能异常者558例（91．32％）。其中表现小气道阻力升高505例（82．65％），大气道阻力升高401例（65．63％）；同时有大、小气道阻力升高348例（56．96％）；呼吸系统静态顺应性降低149例（24．39％），增高6例（0．98％）。279例功能残气量测试，增高46例（16．49％），减少104例（37．28％）。162例支气管舒张试验阳性68例（41．98％）；阴性94例（58．02％）。各项指标均正常53例（9．33％）。结论 本检测方法客观地反映了患儿潮气通气量指标、气道阻力、顺应性、功能残气量情况及气道可逆性，对指导临床诊断治疗及疗效判断有重要的应用意义，正确的操作方法保证了测试结果的准确性和可靠性。     

尿肺炎链球菌抗原检测在儿童肺炎链球菌肺炎诊断中的临床意义

目的：探讨尿肺炎链球菌抗原检测在肺炎链球菌肺炎诊断中的临床意义。方法随机选择下呼吸道感染患儿300例,同时采集患儿痰标本、血标本、尿标本,对痰、血标本进行病原菌培养、鉴定,采用胶体金法检测尿肺炎链球菌抗原。结果300例患儿中,痰培养、血培养和尿肺炎链球菌抗原检测阳性率分别为10．33％（31/300）、15．67％（47/300）和19．33％（58/300）,尿肺炎链球菌抗原检测阳性率高于其他两种方法,血培养检测阳性率高于痰培养（P＜0．05）;尿肺炎球链菌抗原检测诊断肺炎链球菌肺炎的灵敏度和特异度分别为82．98％（39/47）和92．49％（234/253）。结论尿肺炎链球菌抗原检测可作为儿童肺炎链球菌肺炎的辅助诊断依据。     

体位改变对支气管肺炎婴幼儿潮气呼吸肺功能的影响

选取2014年5月~2015年5月我院儿科收治的47例支气管肺炎婴幼儿设为观察组,另随机选取47例腹泻婴幼儿设为对照组,测定对比仰卧和侧卧下两组婴幼儿的潮气量、达峰容积比和达峰时间比。结果对比对照组患儿侧卧位和仰卧位状态下的潮气量、达峰容积比和达峰时间比,差异不存在显著性,无统计学意义(P0.05);观察组患儿侧卧位时的潮气量明显低于仰卧位,达峰容积比和达峰时间比明显高于仰卧位(P0.05)。临床上不同体位下会影响支气管肺炎婴幼患儿的潮气呼吸肺功能,因此临床上对患儿进行潮气呼吸肺功能测定时,需统一体位,护理人员在操作过程中也需加强操作的规范性,以免造成极大的误差。     

BOX-PCR技术在肺炎链球菌检测中应用

目的建立BOX-PCR方法 ,用于肺炎链球菌的检测和流行病学调查。方法用BOX-PCR技术扩增23株肺炎链球菌菌株,并应用50例临床标本检测,同时对方法的特异性、敏感性进行研究。结果对所测肺炎链球菌菌株均获得扩增产物,对其他非肺炎链球菌菌属无交叉反应,其检测敏感性可达101cfu/ml,50例临床标本BOX-PCR方法有9例检测出肺炎链球菌阳性(18.0%),而培养法阳性4例(8.0%)。结论 BOX-PCR方法能快速、特异、灵敏地检测肺炎链球菌和进行流行病学调查。     

婴幼儿肺功能的检测与护理

目的检测婴幼儿患呼吸系统疾患时肺功能状况,研究探讨2600型小儿肺功能仪操作方法,以协助临床诊断并指导治疗.方法采用SensorMedics2600型小儿肺功能仪,对611例呼吸系统疾患婴幼儿进行睡眠时潮气呼吸流速容量(TBFV)环、被动呼气流速容量(PFV)曲线检查,部分患儿进行功能残气量(FRC)测定.结果611例患儿中检出肺功能异常者558例(91.32%).其中表现小气道阻力升高505例(82.65%),大气道阻力升高401例(65.63%);同时有大、小气道阻力升高348例(56.96%);呼吸系统静态顺应性降低149例(24.39%),增高6例(0.98%).279例功能残气量测试,增高46例(16.49%),减少104例(37.28%).162例支气管舒张试验阳性68例(41.98%);阴性94例(58.02%).各项指标均正常53例(9.33%).结论本检测方法客观地反映了患儿潮气通气量指标、气道阻力、颇应性、功能残气量情况及气道可逆性,对指导临床诊断治疗及疗效判断有重要的应用意义,正确的操作方法保证了测试结果的准确性和可靠性.     

青岛地区肺炎链球菌的耐药性检测

目的监测青岛地区肺炎链球菌的耐药性，为临床合理应用抗菌药物提供依据。方法采集青岛地区部分医院2003年1月～2004年12月门诊与住院1973例临床呼吸道感染患者痰、咽拭子标本，培养、分离和鉴定肺炎链球菌。根据NCCLS的推荐，用稀释法、K—B法检测此菌对青霉素等10种抗菌药物的敏感度。结果1973份标本中，检出肺炎链球菌107株（检出率为5．4％），其中44株（41．1％）对青霉素不敏感（22株为中介，22株为耐药株）。肺炎链球菌对头孢噻肟、阿莫西林和氯霉素的耐药率较低，分别为15．0％、15．0％和13．1％，对红霉素、四环素和复方磺胺甲嗯唑有较高的耐药率，分别为73．8％、76．6％和91．6％，未检出对万古霉素耐药的菌株。结论青岛地区青霉素不敏感肺炎链球菌检出率高，除万古霉素外，对其他抗菌药物均有不同程度的耐药。     

婴幼儿肺炎支原体肺炎及肺外并发症120例临床分析

目的:探讨婴幼儿肺炎支原体肺炎(MPP)及肺外并发症的临床特点及诊断要点。方法:回顾分析120例婴幼儿MPP的临床表现、实验室及其他辅助检查结果。结果:120例婴幼儿MPP均有发热,热型多为弛张热,少数为稽留热;均有咳嗽,多为刺激性咳嗽(90例,占75.0%),25例(20.8%)并发喘息症状。MPP除可致呼吸道损伤外,可引起不同程度、不同系统的肺外并发症,受累脏器中以血液、消化、心血管系统多见,其中轻度贫血54例(45.0%),呕吐、腹泻50例(41.7%),心肌损害48例(40.0%)。结论:婴幼儿MPP表现为发热、刺激性咳嗽,肺外并发症多,可累及多个系统及脏器,应予高度警惕,及早诊断和治疗。     

肺炎链球菌的临床分布及耐药性监测

目的了解该院肺炎链球菌的临床分布及监测其耐药变迁,为临床有效抗感染提供参考依据。方法用VITEK 2Compact进行细菌鉴定和药敏数据分析,用WHONET5.3软件和SPSS13.0软件进行统计分析。结果 2008~2013年共分离出588株肺炎链球菌,主要分布于重症监护病房(ICU),其次为呼吸内科、普通儿科;主要来源于痰液标本,其次为咽拭子和血液标本。红霉素耐药率最高,其次为青霉素和复方磺胺甲噁唑;肺炎链球菌对左旋氧氟沙星、氧氟沙星、万古霉素、氯霉素、利奈唑烷仍然敏感。结论肺炎链球菌的耐药率不断上升,应重视细菌耐药性监测,根据药敏试验结果合理选用抗菌药物。     

Chlamydia pneumoniae and Mycoplasma pneumoniae in young children from China with community-acquired pneumonia

Eighty-five cases community-acquired pneumonia (CAP) in children 5 years or younger, confirmed by chest X-ray, and 185 age-matched control patients with diarrhea or dermatitis from the Outpatient Department at Beijing Children's Hospital were enrolled into this study. Nasopharyngeal swab specimens were obtained from all subjects. Real-time PCR-based fluorescence assays were performed for Chlamydia pneumoniae and Mycoplasma pneumoniae. A nested PCR was also run for C. pneumoniae for comparison of assays. C. pneumoniae was found in 3 (3.5%) of CAP cases and in 4 (2.1%) of controls (P = 0.51). M. pneumoniae was found in 6 (7.1%) of CAP cases and in none of the controls (P = 0.001). The agreement rate of the 2 applied PCR methods used for C. pneumoniae detection was 98.5%. Our study demonstrates that M. pneumoniae may play a significant role in CAP affecting children up to 5 years in China, whereas C. pneumoniae in nasopharyngeal specimens was not associated with CAP in this age group.     

小儿肺炎支原体合并肺炎链球菌性肺炎与单纯肺炎支原体体液免疫功能及CT表现比较

目的  探讨小儿肺炎支原体（MP）合并肺炎链球菌（SP）性肺炎与单纯MP体液免疫功能及胸部CT表现的差异。方法  选取本院2020年3月~2022年3月收治的肺炎患儿70例,其中MP感染46例,MP合并SP感染24例,通过检测患儿机体体液免疫指标和观察CT表现,分析两种不同感染类型患儿体液免疫和CT表现间的差异。结果  在病灶分布上两组差异无统计学意义（P＞0.05）;与SP组比较,MP合并SP组支气管血管束增厚、支气管壁增厚、网状影、磨玻璃影和扇形薄片影等影像征象发生率较低,实变影发生率较高,差异有统计学意义（P＜0.05）,MP合并SP组胸腔积液厚度较厚、淋巴结最大横径较大（P＜0.05）;两组患儿IgA、IgG、IgM水平的差异无统计学意义（P＞0.05）。结论  与单纯SP感染相比,MP合并SP感染引起的小儿肺炎体液免疫功能紊乱差异不明显,但在CT影像征象上差异较大,有助于鉴别诊断。     

Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats.

A model of pneumonia due to Streptococcus pneumoniae resistant to penicillin was developed in immunocompetent Wistar rats and was used to evaluate the efficacies of different doses of penicillin, cefotaxime, cefpirome, and vancomycin. Adult Wistar rats were challenged by intratracheal inoculation with 3 x 10(9) CFU of one strain of S. pneumoniae resistant to penicillin (MICs of penicillin, cefotaxime, cefpirome, and vancomycin, 2, 1, 0.5, and 0.5 microg/ml, respectively) suspended in brain heart broth supplemented with 0.7% agar. The rats experienced a fatal pneumonia, dying within 5 days and with peak mortality (70 to 80%) occurring 48 to 72 h after infection, and the bacterial counts in the lungs persisted from 8.87 +/- 0.3 log10 CFU/g of lung at 24 h of the infection to 9.1 +/- 0.3 log10 CFU/g at 72 h. Four hours after infection the animals were randomized into the following treatment groups: (i) control without treatment, (ii) penicillin G at 100,000 IU/kg of body weight every 2 h, (iii) penicillin G at 250,000 IU/kg every 2 h, (iv) cefotaxime at 100 mg/kg every 2 h, (v) cefpirome at 200 mg/kg every 2 h, and (vi) vancomycin at 50 mg/kg every 8 h. Two different protocols were used for the therapeutic efficacy studies: four doses of beta-lactams and one dose of vancomycin or eight doses of beta-lactams and two doses of vancomycin. Results of the therapy for experimental pneumonia caused by penicillin-resistant S. pneumoniae showed that initially, all the antimicrobial agents tested had similar efficacies, but when we prolonged the treatment, higher doses of penicillin, cefotaxime, and cefpirome were more effective than penicillin at lower doses in decreasing the residual bacterial titers in the lungs. Also, when we extended the treatment, vancomycin was more efficacious than penicillin at lower doses but was less efficacious than higher doses of penicillin or cefpirome. The model that we have developed is simple and amenable for inducing pneumonia in immunocompetent rats and could be used to explore the pathophysiology and to evaluate optimal therapy of this infection in the immunocompetent host.     

婴幼儿先天性心脏病术后呼吸机相关性肺炎病原菌分布及药敏变迁

目的 调查武汉市儿童医院婴幼儿先天性心脏病术后呼吸机相关性肺炎病原菌分布及耐药情况,为临床合理使用抗菌药物提供依据.方法 回顾性分析2010年1月至2012年11月武汉市儿童医院心脏外科婴幼儿先天心脏病术后并发呼吸机相关相关性肺炎病例,对此类患儿分离出的病原菌,采用VITEK2Jr全自动细菌鉴定及药敏分析系统鉴定细菌类别,纸片扩散(K2B)法进行药敏试验.对药敏结果采用WHONET 5.0系统软件进行分析.结果 2010年检出16株病原菌,革兰氏阴性菌9株(前两位是肺炎克雷伯杆菌18.75％,鲍曼氏不动杆菌12.5％);革兰氏阳性球菌6株(链球菌18.75％为主),真菌1株.2011年检出32株病原菌,革兰氏阴性菌24株(前三位是鲍曼氏不动杆菌31.25％,肺炎克雷伯杆菌25％,铜绿假单胞菌6.25％),革兰氏阳性球菌8株(肠球菌12.5％,链球菌6.25％).2012年检出42株病原菌,革兰氏阴性菌38株(肺炎克雷伯杆菌33.33％,鲍曼氏不动杆菌26.19％,铜绿假单胞菌21.42％),革兰氏阳性球菌4株(肠球菌4.76％为主).鲍曼氏不动杆菌对对阿米卡星、左氧氟沙星敏感率最高,但对美罗培南、亚胺培南耐药.肺炎克雷伯杆菌对阿米卡星、左氧氟沙星敏感最高,对头孢哌酮/舒巴坦、美罗培南、亚胺培南、复方新诺明、环丙沙星耐药.铜绿假单胞菌自2012年起仅对左氧氟沙星、哌拉西林/他唑巴坦敏感.革兰氏阳性球菌所占比例逐年降低,多以肠球菌及链球菌为主,葡萄球菌逐年减少,但未发现万古霉素耐药菌株.结论 婴幼儿先心病术后呼吸机相关性肺炎优势病原菌为革兰氏氏阴性菌,以肺炎克雷伯菌、鲍曼氏不动杆菌和铜绿假单胞菌为主,且耐药性呈增加趋势,临床应依据细菌病原学及耐药性资料,合理选择抗菌药物.     

HMR 3647 human-like treatment of experimental pneumonia due to penicillin-resistant and erythromycin-resistant Streptococcus pneumoniae

An experimental Streptococcus pneumoniae pneumonia model in rabbits was used to assess the efficacy of amoxycillin, erythromycin and a new ketolide, telithromycin (HMR 3647). The MICs of amoxycillin, erythromycin and HMR 3647 for the three clinical S. pneumoniae strains used were, respectively, (mg/L): 0.01, 16 and 0.02 (strain 195); 2, 0.25 and 0.02 (strain 16089); 8, >64 and 0.02 (strain 11724). Antibiotic therapy reproduced human serum pharmacokinetics (amoxycillin 1 g iv tds or erythromycin 500 mg qds or HMR 3647 800 mg bd). Forty-eight hours of therapy with HMR 3647 and amoxycillin resulted in significant bacterial clearance in the lungs and spleen of rabbits infected by S. pneumoniae strain 195 and strain 16089 (at least 3 log(10) cfu/g decrease, P < 0.001). Erythromycin was active against only the erythromycinsusceptible strain (3 log(10) cfu/g decrease at 48 h, P < 0.001). None of the antibiotics showed significant efficacy with strain 11724. All agents produced significant bacterial clearance when time above MBC was >33%, and microbiological failure when it was <25%, whereas MIC was not correlated with microbiological outcome with HMR 3647. Our findings suggest that pharmacodynamic data integrating MBC may be predictive of microbiological success or failure with greater accuracy than with MIC. HMR 3647 produced significant bacterial clearance in both penicillin- and erythromycin-resistant pneumonia, but was less effective against the highly erythromycin-resistant S. pneumoniae strain.     

Prevalence and clinical characteristics of septicemia in children with Mycoplasma pneumoniae pneumonia

BackgroundMycoplasma pneumoniae (MP) pneumonia in children can be challenging to treat, and the impact of MP blood infection is unclear. The present study aims to determine the prevalence and clinical characteristics of MP septicemia among pediatric patients.MethodsChildren hospitalized at our center for MP pneumonia between October 2017 and June 2018 were included. Healthy controls visiting our outpatient clinic for regular physical examinations were also enrolled. MP was detected by real-time polymerase chain reaction (qPCR) analysis of plasma and peripheral blood mononuclear cell (PBMC) samples.ResultsSixty-one children with MP pneumonia and 30 healthy children were included. Among children with MP infection, 31 (50.8%) were positive for MP by qPCR (19 in plasma samples, 8 in PBMC samples, and 4 in both). All healthy controls were negative for MP by qPCR.ConclusionsThe prevalence of MP septicemia in children with MP pneumonia is moderate. However, detection of MP in blood samples may have limited clinical value for guiding treatment.     

Primary subcutaneous abscess due to Streptococcus pneumoniae

A primary subcutaneous abscess and associated bacteremia due to Streptococcus pneumoniae, type 9V, occurred in a healthy 23-year-old man. Penicillin therapy and surgical drainage were curative.     

Concurrent community-acquired pneumonia with Legionella pneumophila and Streptococcus pneumoniae

Both Streptococcus pneumoniae and Legionella pneumophila are well defined causes of community-acquired pneumonia, and may be associated with substantial mortality. Optimal therapy consists of penicillin for the former organism and erythromycin for the latter. We have presented a case of pneumonia caused by simultaneous infection with both of these agents. Organisms were recovered either from blood or lung tissue. This case carries important implications for treatment of community-acquired pneumonia, and conceivably could explain some of the mortality that continues to be seen with pneumococcal pneumonia.