儿童泌尿系感染临床管理现状分析

目的初步了解儿童泌尿系感染临床管理现状,为今后制订适于我国实际的临床指南提供参考。方法对自1994年至2003年间入院诊断泌尿系感染(泌感)的患儿病史进行回顾性分析,通过电话回访了解出院后的随诊情况。结果74例入院诊断泌感的患儿,最终仅有20例(27.0%)符合严格的泌尿系感染诊断标准。仅有11例(14.9%)完成多项影像学检查(包括B超及膀胱输尿管反流筛查),膀胱输尿管反流阳性2例。回访成功41例,其中仅13例(31.7%)出院后在门诊定期随诊,8/13例仍有反复泌尿系感染。结论①按照严格的泌尿系感染诊断标准,许多入院时的泌感诊断不能成立,将被纠正;②寻找泌感潜在病因时影像学检查不够充分,这可能是膀胱输尿管反流诊断率相对低(2/20例,10.0%)的原因之一;③泌感患儿随诊率极低,有碍于控制泌感复发。今后确应重视小儿泌尿系感染的严格诊断程序、影像学检查及随诊管理。

Evaluation of clinical management on children with urinary tract infection(UTI)

Objective To evaluate the status of clinical management based on the analysis of children admitted with the diagnosis of urinary tract infection (UTI),which will be helpful to work out a practical guideline of UTI in China in the near future. Methods From 1994 to 2003,74 hospitalization children with the initial diagnosis of UTI were analyzed retrospectively.Parents of the UTI children were contacted by phone call to obtain the follow_up data. Results Among 74 cases with initial diagnosis of UTI,only 20 cases(27%)met the strict diagnosis criteria of UTI.The complete imaging evaluation,including renal ultrasound and screening for vesicoureteral reflux (VUR),was carried out only in 11 of 74 (15%),and 2 cases with positive findings of VUR.There were only 13 patients (32%)paid return visit,and 8/13 had recurrence UTI. Conclusions (1)According to the strict diagnosis criteria of UTI,the initial diagnosis of UTI in many cases cannot be set up.(2)The whole imaging evaluation was performed in a small portion of patient, which may be the reason of the low incidence of VUR (2/20 cases, 10%) in this group.(3)The patient number of follow_up in UTI is quite low, which may be adverse to prevent the recurrence of UTI and development of renal scarring.