儿童大叶性肺炎病原及临床特征与治疗研究

目的分析儿童大叶性肺炎的临床特征、病原菌构成情况及药敏试验结果,为治疗方案的选择提供参考。方法回顾性分析广东省妇幼保健院2016年12月-2018年12月收治的140例符合纳入条件的大叶性肺炎患儿临床资料,整理患儿感染病原菌分布及构成情况。患儿基本资料(性别、年龄、患病季节、生命体征、临床症状、实验室指标、影像学表现),治疗方案及临床疗效,探讨儿童大叶性肺炎治疗方案。结果整理患儿病例信息,统计显示:患儿性别以女童为主,发病年龄集中在7岁以下,广东地区全年均可发病,季节性不明显。140例患儿中,影像学确诊时已出现临床症状时间为(4.35±0.42)d。病原学确诊时间为出现临床症状(6.14±1.03)d。经血培养、呼吸道及体液微生物培养,共检出病原体152株,以肺炎支原体为主,其次为肺炎链球菌、金黄色葡萄球菌,其他病原菌14株,未检出病原菌16例,混合感染24例。胸片左中下肺野阴影59例,右中下肺野大片状阴影56例,右中上肺野大片阴影25例。肺不张患儿24例。所有患儿确诊后均行经验性抗菌药物治疗,部分患儿根据炎症情况、免疫功能情况选择抗炎药物及免疫功能改善治疗,或病情危重者选择支气管灌洗治疗,不同方法均获得较好临床疗效。结论大叶性肺炎患儿年龄较小,影像学确诊前临床症状及体征特异性差,混合病原菌感染常见,应密切观察病情变化,采用综合治疗措施,尽快控制感染及炎症状态,提升免疫功能,避免影响其他脏器功能,提升临床疗效。

Study on the pathogen,clinical characteristics and treatment of lobar pneumonia in children

Objective To analyze the clinical characteristics,pathogen composition and drug sensitivity test results of children with lobar pneumonia,and to provide reference for the selection of treatment regimens.Methods The clinical data of 140 children with lobar pneumonia admitted to our hospital from December 2016 to December 2018 were analyzed retrospectively.The distribution and composition of pathogenic bacteria in children,basic data of the children(sex,age,disease season,vital signs,clinical symptoms,laboratory indicators,imaging manifestations),treatment plan and clinical efficacy were analyzed to explore the treatment plan of lobar pneumonia in children.Results The results showed that the gender of the children with lobar pneumonia was mainly girls,and the age was mainly under 7 years old.The disease can occur in Guangdong all the year round,and the seasonality is not obvious.Among the 140 cases,the mean time of onset of clinical symptoms at the time of imaging diagnosis and the time of etiological diagnosis was(4.35±0.42) days and(6.14±1.03) days,respectively.A total of 152 pathogens were detected in blood culture,respiratory tract culture and humoral culture,mainly mycoplasma pneumoniae,followed by streptococcus pneumoniae and staphylococcus aureus,and 14 other pathogenic bacteria were detected.No pathogen was detected in 16 cases.Mixed infection was found in 24 cases.There were 59 cases with shadow in the left middle and lower lung field,56 cases with large patchy shadow in the right middle and lower lung field,and 25 cases with large shadow in the right middle and upper lung field.Twenty-four children with atelectasis were diagnosed.All children were treated with empirical antimicrobial agents after diagnosis,and some children were treated with anti-inflammatory drugs and improved immune function according to inflammation and immune function,or with bronchial lavage for critically ill patients.All the treatment obtained good clinical efficacy.Conclusion Children with lobular pneumonia are younger There were poor specificity of clinical symptoms and signs before imaging diagnosis.Mixed pathogen infection is common.c It is necessary to closely observe the changes of the disease,adopt comprehensive treatment measures to control the infection and inflammation as soon as possible,improve the immune function,avoid affecting the function of other organs,and improve the clinical efficacy.