儿童重症肺炎病原体检测与诊治分析  

Detection of pathogens and treatment of children with severe pneumonia

作　　者：谢鹤[1] 王朋朋[1] 李贵才[1] 杨镒宇 金颖康 陈默蕊[1] 罗招云[1] 

机构地区：[1]广东省潮州市中心医院,521021 [2]广州市妇女儿童医疗中心,510000

出　　处：《中国小儿急救医学》2014年第5期281-284,共4页Chinese Pediatric Emergency Medicine

基　　金：广州市卫生科技重点项目（2009-ZDi-15）

摘　　要：目的 探讨本院儿童重症肺炎病原体的检测情况.方法 采用无菌培养基对痰液、静脉血标本进行细菌培养;间接免疫荧光法检测病毒、非典型病原体抗体,RT-PCR检测甲型H1N1流感病毒核酸。根据培养及药敏试验结果指导抗生素的使用,针对并发症进行抗炎、器官功能支持和其他个体化治疗。结果 123例患儿痰细菌培养阳性患儿69例（56.10％）,其中革兰阴性菌50株（57.47％）,革兰阳性菌37株（42.53％）.革兰阴性菌主要为流感嗜血杆菌18株（20.96％）、大肠埃希菌13株（14.94％）、肺炎克雷白菌12株（13.79％）;革兰阳性菌以金黄色葡萄球菌19株（21.84％）、肺炎链球菌14株（16.10％）为主。89例脓毒症患儿血培养阳性7例（8.00％）。病毒感染11例,其中呼吸道合胞病毒抗体阳性2例,腺病毒抗体阳性2例,乙型流感病毒抗体阳性4例,副流感病毒抗体阳性2例,甲型H1N1流感病毒感染1例.肺炎支原体感染8例。123例患儿并发脓毒症89例（72.36％）,呼吸衰竭85例（69.11％）,胃肠功能障碍48例（39.02％）,心力衰竭32例（26.02％）,脓毒性休克18例（14.63％）,中毒性脑病13例（10.57％）,弥散性血管内凝血5例（4.07％）,其中多器官功能障碍17例（13.82％）。治愈46例（37.4％）,好转出院73例（59.35％）,死亡4例（3.25％）,死亡病例均合并严重并发症.结论 儿童重症肺炎病原体检出率高,不能忽略并发症的个体化救治,以提高救治成功率。Objective To discuss pathogens findings in children with severe pneumonia.Methods Bacteria was detected by using sputum culture and blood culture in sterile culture media.Viruses and atypical pathogenic antibodies were detected by using indirect immunofluorescence.Influenza A （H1N1） virus RNA were tested using RT-PCR.According to the results of bacterial culture and drug sensitive test,we can guide the use of antibiotics,and individualize treatment was carried out,including anti-inflammatory,organ function support.Results Bacteria was found in 69 children by using sputum culture.Gram negative bacteria accounted for 57.47％.Gram positive bacteria accounted for 42.53％.Escherichia coli（14.94％）,Haemophilus influenzae （20.96％） and klebsiella pneumoniae（13.79％） were the main strains of Gram negative bacteria,Staphylococcus aureus （21.84％）and Streptococcus pneumonia（16.1％）were the main strains of Gram positive bacteria.Bacteria was found in 7 （8.00％） children by using blood culture.Virus were identified in 11 out of 123 patients,including 2 cases of respiratory syncytial virus antibody positive,2 cases of adenovirus antibodies positive,4 cases of influenza B virus antibody positive,2 cases of parainfluenza virus antibody positive and influenza A（H1N1） virus from only one case,Mycoplasma pneumonia agents were identified in 8 patients.Eighty-nine children （72.36％） complicated with sepsis,85 children （69.11％） with respiratory failure,48 children （39.02％） with gastrointestinal dysfunction,32 children （26.02％） with heart failure,18 children（14.63％） with septic shock,13 cases （10.57％） with toxic encephalopathy,5 children （4.07％） with disseminated intravascular coagulation.Among them,17 children （13.82％） complicated with multiple organ dysfunction syndrome.In the 123 children with severe pneumonia,46 cases （37.4％） were cured,73 cases （59.35％） improved,and 4 cases died （3.25％） with critical multiple organ dysfunction

关 键 词：重症肺炎 病原体 并发症 儿童 

分 类 号：R725.6[医药卫生—儿科]