婴幼儿接种卡介苗后30例淋巴结异常反应分析

目的分析婴幼儿接种卡介苗（BCG）后淋巴结异常反应的原因与处理方法。方法对2004年1月-2010年9月间武汉市医疗救治中心收治的30例接种BCG后淋巴结异常反应的患儿临床资料进行回顾性分析。30例患儿均于接种BCG3-6个月后接种侧腋下及锁骨上淋巴结肿大,胸片与血沉正常,PPD试验（＋）,均无全身结核中毒症状。结果 20例淋巴结直径≤4 cm的患儿仅给予异烟肼口服或加环形封闭治疗2-3个月痊愈;另3例淋巴结〉4 cm者行手术摘除。5例淋巴结化脓者在口服异烟肼治疗的同时,行穿刺抽脓、冲洗及并注入链霉素和异烟肼治疗,3-4周均痊愈。另2例有破溃者经切开排脓,冲洗、使用蘸有利福平粉的凡士林纱条引流及5%异烟肼软膏外敷治疗后痊愈。结论提高接种BCG的技术、接种质量和恰当处理BCG接种后的淋巴结异常反应,是预防与降低BCG接种后淋巴结异常反应发生率的关键措施。

Analysis on 30 Cases of Infants with Lymph Nodes Abnormal Responses After Inoculation with BCG Vaccine

Objective To analyze the causes and disposals of lymph nodes abnormal responses after BCG vaccination on 30 infants. Methods The clinical data of 30 infants with lymph nodes abnormal responses after BCG vaccination hospitalized in Wuhan Medical Treatment Center from January 2004 to September 2010 were retrospectively analyzed.Thirty infants had enlarged alar and supraclavicular lymph nodes in inoculated side at 3～6 months after inoculation with BCG vaccine.The results of chest X-ray and blood sedimentation were normal.PPD skin test showed(+).No systemic tuberculosis poisoning symptoms were found. Results Twenty infants with the diameter of lymph node ≤ 4 cm who received isoniazid orally or added ring seal treatment for 2～3 months were healed.Three infants with the diameter of lymph node > 4 cm received surgical excision.5 infants with suppurative lymph node who received isoniazid orally were given abscess puncture aspiration,flushing,injections of streptomycin and isoniazid simultaneously,after 3～4 weeks of treatment,the 5 infants were cured.And 2 infants with ulcerated lymph node were healed through receiving abscess incision,flushing, drainage with vaseline gauze dressing and rifampicin powder,and external application of 5% isoniazid ointment. Conclusions The technique and the quality of BCG vaccination as well as proper disposal are the key measures to prevent and decrease the incidence rate of lymph nodes abnormal responses after BCG vaccination.