| 摘要: |
| 目的:分析总结儿童坏死性肺炎(NP)的临床特征及诊治方法,以提高儿科临床对NP的诊疗水平。方法:回顾性分析2012年6月至2015 年6月在自贡市第一人民医院接受治疗的47例NP患儿的临床资料,总结儿童NP的临床表现、影像学特征、病原学特点、治疗方法及预后。结果:47例患儿均表现出持续发热、咳嗽,部分伴有肺部湿啰音。病原学检查结果显示,11例细菌培养阳性(分别为肺炎链球菌5例、金黄色葡萄球菌2例、鲍曼不动杆菌2例、草绿色链球菌2例,其中7例合并肺炎支原体IgM抗体阳性),35例细菌培养结果阴性(其中14例单纯肺炎支原体IgM抗体阳性,9例单纯肺炎衣原体IgM阳性,6例肺炎支原体IgM抗体阳性合并肺炎衣原体IgM抗体阳性,6例病原学检查结果均阴性),1例白假丝酵母菌培养阳性。胸部CT检查结果显示,所有患儿均可见多发性小空洞,16例合并胸腔积液。所有患儿均给予茁鄄内酰胺类抗生素静脉滴注,并酌情给予头孢吡肟、美罗培南、利奈唑胺、万古霉素、阿奇霉素和(或)红霉素治疗,胸腔穿刺治疗16例,随访3~6个月,所有患儿均预后良好。结论:儿童NP可能与肺炎支原体(MP)或衣原体(CP)感染有关,但不能除外细菌感染,该病热程及病程较长,影像学表现明显,积极采取抗生素治疗可取得良好预后。 |
| 关键词: 坏死性肺炎 临床特点 诊治方法 儿童 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.07.008 |
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| 基金项目: |
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| Clinical Characteristics, Diagnosis and Treatment of Childhood Necrotizing Pneumonia |
| Lin Yuantao1 , Yang Guang2 , Wang Hongyu1 , Gong Feng1 , Wu Hengping1 |
| (1. Zigong First People's Hospital, Sichuan Zigong 643000, China; 2. The General Hospital of the People's Liberation Army, Beijing 100853, China) |
| Abstract: |
| Objective: To explore the clinical characteristics, diagnosis and treatment of childhood necrotizing pneumonia (NP) in order to improve the diagnosis and treatment effect. Methods: Clinical data of 47 cases of NP in children that diagnosed in our hospital from June 2012 to June 2015 were retrospectively analyzed. The clinical manifestations, imaging characteristics, etiological haracteristics, therapeutic method and prognosis were contented. Results: Forty-seven cases showed persistent fever, cough, partial children accompanied by pulmonary rales. Pathogen detection results showed 11 cases with germiculture positive (5 cases with Streptococcus pneumoniae, 2 cases with Staphylococcus aureus, 2 cases with Acinetobacter baumannii, 2 cases with Streptococcus viridians. Seven cases with merger Mycoplasma pneumoniae IgM antibody positive), 35 patients with negatie results of bacterial culture (including 14 cases of pure Mycoplasma pneumoniae IgM antibody positive, 9 cases of Pneumonia chlamydia IgM antibody positive, 6 cases of Mycoplasma pneumoniae IgM antibody positive merger chlamydia IgM antibody positive, 6 cases of etiology negative), 1 case of White candida culture positive. All the children had undergone chest CT. Imaging feature was multiple small holes. 16 cases also were of pleural effusion. All patients were given β lactam antibiotics intravenous infusion therapy, and to give appropriate cefepime, meropenem, linezolid, vancomycin, azithromycin and (or) erythromycin treatment. Ten cases were given pleural puncture, follow up 3 to 6 months. All the patients had good prognosis. Conclusion: NP in children may be associated with MP and CP infection, not excluding bacterial infections. The disease had longer duration of thermal process and heavier of imaging findings. NP in children can achieve good prognosis while take antibiotics actively. |
| Key words: necrotizing pneumonia clinical characteristics diagnosis and treatment children |
