儿童社区获得性重症肺炎272例治疗效果分析  

Analysis of treatment effectiveness of 272 cases of severe community-acquired pneumonia in children

作　　者：杨小青[1] 黄英[1] 舒畅[1] 罗蓉[1] 陈沅[1] 杨永弘[2] 

机构地区：[1]重庆医科大学附属儿童医院呼吸中心,重庆400014 [2]首都医科大学附属北京儿童医院儿科研究所,北京100045

出　　处：《重庆医科大学学报》2010年第10期1580-1583,共4页Journal of Chongqing Medical University

基　　金：国家科技部十五攻关项目资助(编号:2004BA720A09-01)

摘　　要：目的：分析儿童社区获得性重症肺炎的临床治疗情况,为提高治愈率及降低死亡率提供理论依据。方法：收集重庆医科大学附属儿童医院2008年12月~2009年11月收治的272例社区获得性重症肺炎患儿的临床资料,重点对治疗及预后情况进行统计分析。结果：（1）272例患儿中,治愈194例,好转54例,治疗有效率91.2%,未愈17例,死亡7例,治疗无效率8.8%,病死率2.57%,为同期儿童肺炎总死亡率的11.5倍。（2）经验性治疗组疗效明显高于经验治疗无效后改为针对性治疗组,且差异有统计学意义;激素治疗组与非激素治疗组,机械通气组与非机械通气组,血管活性药物组与非血管活性药物组在疗效上也有显著的统计学差异。支持治疗组的疗效优于非支持治疗组,但差别无统计学意义。结论：儿童重症肺炎强调综合治疗原则。初始正确合理选用抗生素对改善预后极为关键。临床医师应根据患儿临床情况、当地病原流行病学特点及细菌药敏结果等选择初始经验性用药。在有效使用抗生素的基础上,合理、短期使用小剂量激素可改善患儿预后。血管活性药物和支持辅助治疗可提高重症肺炎治疗效果。对发生严重通换气障碍的患儿应及时予以机械通气呼吸支持治疗。Objective：To analyze the clinical treatment of childhood severe community-acquired pneumonia,in order to provide theoretical evidence for improving the cure rate and decreasing mortality rate. Methods：272 children with severe community-acquired pneumonia were admitted in Chongqing Children’s Hospital from December 2008 to November 2009.Their clinical data ,especially the condition of treatment and prognosis,were collected and statistically analyzed.Results：（1）In 272 children,194 were cured and 54 improved their condition ,with treatment efficiency being 91.2%;17 quitted the treatment and 7 died,with treatment inefficiency being 8.8%,and mortality being 2.57%,accounting for 11.5 times as much as the overall mortality of pneumonia in children in the same period. （2）The efficiency of empirical therapy group was significantly higher than another group which were changed to specific treatment after ineffective empirical treatment ,and the difference was statistically significant. There were statistical significant differences between groups of hormone therapy and non-hormone therapy,mechanical ventilation and non-mechanical ventilation,vasoactive drugs therapy and non-vascular active drug treatment. The efficiency of supportive treatment was better than that of non-supportive treatment group ,but the difference was not statistically significant. Conclusion：Comprehensive treatment should be emphasized in childhood severe pneumonia. Reasonable selection of initial antibiotics is critical for improving the prognosis of severe pneumonia. Clinicians should pay attention to the clinical conditions of patients,epidemiological features of local pathogens and antibiotic susceptibility test when choosing the initial empirical drug. Based on the effective antibiotic therapy ,a reasonable,short-term use of small doses of hormones can improve the prognosis. Vasoactive drug and supportive therapy can improve the curative effect. Mechanical ventilation should be used timely if children develop serious breathing dis

关 键 词：重症肺炎 儿童 治疗 预后 

分 类 号：R725.6[医药卫生—儿科]