细菌感染致儿童坏死性肺炎16例诊治分析

doi:10.7504/ek2014060611

摘要/Abstract

摘要：

目的总结细菌感染致坏死性肺炎患儿的临床特点，提高诊治水平。方法回顾性分析2008年1月至2013年7月深圳市儿童医院收治的16例影像学诊断符合坏死性肺炎患儿的临床资料、影像学特点、病原学、治疗及预后。结果男9例，女7例，年龄4个月至6岁［平均（1.7±1. 5）岁］， 15例既往健康。16例均咳嗽、有痰、发热，体温（39.4±0.5）℃，热程6～31（16.4±8.0） d，治疗1～21（9.1±5.1） d后热退。住院时间11～53（21.4±11.2） d。WBC ＜5×109/L 者3例，（5～12）× 109/L者3例，＞12×109/L者10例，平均（30.20±12.3）×109/L。中性粒细胞比例0.73±0.12。16例CRP增高，33.3～231.0（115.1±73.3 ） mg/L。病程3～18（11.4±4.0） d时胸部X线平片或CT可发现肺部囊性病灶。右肺叶受累多见，均未见纵隔肺门淋巴结肿大。胸腔积液或血培养明确病原7例，肺炎链球菌2例，金黄色葡萄球菌2例，铜绿假单胞菌3例（其中1例肺炎支原体抗体1∶1280）；其中3例与痰培养病原一致。13例使用万古霉素和（或）亚胺培南治疗；5例加用阿奇霉素或红霉素。9例行胸腔闭式引流，其中1例行胸腔脓肿切开引流术及纤维板剥离术；均未行肺叶切除术。所有病例出院后6个月内随访X线平片或CT，提示肺部病灶大部分吸收或基本吸收。结论儿童坏死性肺炎热程及病程长、血象高、影像学表现较重，但及时抗感染治疗远期预后较好。肺炎链球菌、金黄色葡萄球菌是较为常见的病原，铜绿假单胞菌值得关注。

关键词: 儿童, 坏死性肺炎, 铜绿假单胞菌

Abstract:

Abstract： Objective To summarize the clinical characteristics of childhood necrotizing pneumonia due to bacterial infection. Methods Clinical features， radiographic manifestations， etiology， treatment and prognosis of 16 cases diagnosed as childhood necrotizing pneumonia according to radiographic manifestations were analyzed retrospectively. Results There were 9 boys and 7 girls in all 16 cases（average age 1.7±1.5 years）. The majority of the patients included in our study are previously healthy. All patients，whose average hospitalization time was 21.4±11.2 days， were suffering from cough， sputum and fever （heat peak 39.4±0.5 ℃， fever process 16.4±8.0 days and fever clearance time after treatment 9.1±5.1 days）. The average hospitalization time was 21.4±11.2 days. The white blood cell count （mean value 30.20±12.3×109/L， neutrophils ratio 0.73±0.12） were ＜5×109/L in 3 cases，（5～12） ×109/L in 3 cases， and ＞12×109/L in 10 cases. All cases showed a significant rise in C-reactive protein （mean value 115.1±73.3mg/L）. In the period of 11.4±4.0 days， cystic lesions in lung，which was more common on right lobe， could be found by chest X-ray or CT. In 7 cases， pleural fluid or blood culture was positive， respectively Streptococcus pneumoniae （2 cases）， Staphylococcus aureus （2 cases） and Pseudomonas aeruginosa （3 cases， one of which coinfection with Mycoplasma pneumoniae）. There were 13 cases which had Vancomycin and/or Imipenem treatment， and 5 cases were added Azithromycin or Erythromycin. Closed thoracic drainage was used in 9 cases， one of which had pleural abscess incision and drainage and fiberboard dissection. None of all cases had pulmonary lobectomy. The pulmonary lesions were mostly or practically absorbed in all cases with in 6 months in follow-up. Conclusion Long duration and fever process， high level of WBC and severe radiographic performance are usually shown in childhood necrotizing pneumonia. The common pathogen of childhood necrotizing pneumonia are Streptococcus pneumoniae and Staphylococcus aureus， but Pseudomonas aeruginosa is worth noticing as well. After timely anti-infective therapy， most childhood necrotizing pneumonia has favorable long-term prognosis.

Key words: children, necrotizing pneumonia, Pseudomonas aeruginosa

中图分类号:

Ｒ72

马红玲a，陈杰华a，杨方方a，孙洁b，郑跃杰a，鲍燕敏a. 细菌感染致儿童坏死性肺炎16例诊治分析[J]. 中国实用儿科杂志, DOI: 10.7504/ek2014060611.

MA Hong-ling，CHEN Jie-hua，YANG Fang-fang， SUN Jie， ZHENG Yue-jie， BAO Yan-min.. Analysis of the diagnosis and treatment of 16 cases of childhood necrotizing pneumonia due to bacterial infection.[J]. Acta Metallurgica Sinica, DOI: 10.7504/ek2014060611.

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