儿童重症喘憋性肺炎并发气胸20例临床分析  

Clinical Analysis of 20 Cases Severe Asthmatic Pneumonia Complicated with Pneumothorax in Children

作　　者：臧平[1] 卢秀兰[1] 蔡汶静[1] 祝益民[1] 

机构地区：[1]湖南省儿童医院,湖南长沙410007

出　　处：《儿科药学杂志》2013年第12期28-30,共3页Journal of Pediatric Pharmacy

摘　　要：目的:总结儿童重症喘憋性肺炎并发气胸的临床特点、治疗方法及转归,为临床及时认识和早期诊治提供依据。方法:收集我院重症医学科2010年12月至2012年4月收治的20例重症喘憋性肺炎并发气胸患儿,对其临床表现、实验室检查、病原学、影像学、治疗方法及临床转归进行总结和分析。结果:(1)患儿发病高峰季节为冬春季节,临床表现以喘憋、咳嗽、呼吸窘迫、发绀、发热等为主;(2)20例患儿经痰培养等病原学检查共检出病原19株,其中肺炎支原体10株(52.6%),呼吸道合胞病毒2株(10.5%),腺病毒2株(10.5%),细菌5株(26.3%);(3)单侧气胸8例(左侧2例,右侧6例),双侧气胸12例;(4)并发皮下气肿8例,纵膈气肿7例,胸腔积液4例;(5)治疗方法采用胸腔闭式引流16例(80.0%),气管插管18例(90.0%);(6)转归:治愈9例(45.0%),好转7例(35.0%),放弃1例(5.0%),死亡3例(15.0%)。结论:儿童重症肺炎除需警惕脓胸、脓气胸外,对于冬春季节发病的学龄前儿童,伴有明显喘憋症状者,虽感染指标无明显升高,临床上仍应高度警惕气胸的发生,如能及时识别及干预治疗,则预后良好。Objective： To investigate the clinical features, therapeutic method, prognosis of severe asthmatic pneumonia in children and provide evidence for early identification and clinically treatment. Methods： Twenty cases of severe asthmatic pneumonia complicated with pneumothorax were enrolled who hospitalized in pediatric intensive care unit （PICU） during December 2010 to April 2012. Their clinical symptoms, laboratory tests, pathogens, radiological results, treatment and clinical outcomes were analyzed. Results： （1） Severe asthmatic pneumonia complicated with pneumothorax has higher incidence in winter and spring. The clinical symptoms included wheezing, cough, respiratory distress, cyanosis, fever etc. （2） Nineteen strains pathogens were detected etiological examination, mycoplasma infection 10 cases （ 52. 6% ）, respiratory syncytial virus infection 2 cases （ 10. 5% ）, adenovirus infection 2 cases （ 10. 5% ）, bacterial infection 5 cases （26.3%）. （3） Unilateral pneumothorax 8 cases, left side 2 cases, right side 6 cases. Bilateral pneumothorax 12 cases. （4） Complicated by subcutaneous emphysema 8 cases, pneumomediastinum 7 cases, pleural effusion 4 cases. （5） Closed drainage of pleural cavity 16 cases, endotracheal intubation 18 cases. （6） Prognosis： 9 cases （45.0%） cured, 7 cases （35.0%） improved, 1 case （5.0%） abandoned, 3 cases （15.0%） dead. Conclusions： Besides emphysema and pus pneumothorax, severe pneumonia with wheezing in preschoolers, especially occur in winter and spring, is easily to complicated by pneumothorax although with normal infection index. Early identification and intervention can improve the prognosis.

关 键 词：重症肺炎 喘憋 气胸 儿童 

分 类 号：R725.6[医药卫生—儿科]