70例儿童重症7型腺病毒肺炎的临床观察  

Clinical observation of 70 children with severe pneumonia induced by adenovirus type 7

作　　者：陈飞燕 党润 彭红艳 杨文敏 张春敏 左云龙 洪婕 赵明奇 陈翊 杨镒宇 Chen Feiyan;Dang Run;Peng Hongyan;Yang Wenmin;Zhang Chunmin;Zuo Yunlong;Hong Jie;Zhao Mingqi;Chen Yi;Yang Yiyu(Pediatric Intensive Care Unit,Guangzhou Women and Children Medical Center,Guangzhou 510120,China;Central Laborary,Guangzhou Woment and Children Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心儿童重症监护室(儿童院区),510120 [2]广州市妇女儿童医疗中心中心实验室,510120

出　　处：《中国小儿急救医学》2020年第8期587-590,共4页Chinese Pediatric Emergency Medicine

基　　金：广州市科技计划项目(201803040004);广州市卫生健康科技项目(20191A011020)。

摘　　要：目的分析儿童重症7型腺病毒肺炎临床特点及治疗结果,探讨儿童重症7型腺病毒肺炎的治疗方法。方法回顾性分析2016年1月至2019年10月广州市妇女儿童医疗中心儿童重症监护病房收治的70例重症7型腺病毒肺炎患儿的临床资料,描述性分析重症7型腺病毒肺炎患儿的临床情况、治疗经过及结局。结果(1)70例重症7型腺病毒肺炎患儿,男43例(61.4%),女27例(38.6%);0~12个月30例(42.9%),13~36个月28例(40.0%),>36个月12例(17.1%)。(2)入PICU前发病时间(11.87±7.10)d;入PICU 6 h内序贯器官功能衰竭评分为6.80±3.13;Murray肺损伤评分为2.49±1.15;P/F值(150.57±86.25)mmHg(1 mmHg=0.133 kPa)。X线胸片受累程度达2个象限及以上的有64例(91.4%);所有患儿诊断脓毒症。(3)实验室检查:白细胞计数(7.6±5.5)×10^9/L,血小板计数(238.8±164.2)×10^9/L,C反应蛋白(39.4±37.2)mg/L。(4)治疗方案和结局:65例(92.9%)使用静脉丙种球蛋白;45例(64.3%)使用过激素;43例(61.4%)进行了纤维支气管镜探查或冲洗;21例(30.0%)进行了血液净化治疗;63例(90.0%)进行了无创或有创呼吸机治疗,其中20例(28.6%)患儿使用了高频呼吸机辅助通气;6例(8.6%)使用了肺泡表面活性物质;19例(27.1%)使用体外膜肺氧合治疗。呼吸机平均治疗时间(13.10±11.58)d;PICU中体温降至正常时间为(4.69±4.01)d;平均入住PICU时间(15.76±12.20)d;平均住院天数(27.04±13.10)d。16例患儿死亡,病死率22.9%。结论儿童重症7型腺病毒肺炎病情危重、肺损伤显著,虽经体外膜肺氧合等积极治疗,仍具有较高的病死率。Objective To explore more clinical characteristics and outcomes of children with severe pneumonia induced by adenovirus type 7(Adv-7).Methods Seventy children with severe pneumonia induced by Adv-7 admitted to the pediatric intensive care unit of Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were enrolled.The clinical features,treatments and outcomes of these children were recorded.Results(1)There were 43 males(61.4%)and 27 females(38.6%).Thirty(42.9%)patients were 0-12 months old,28(40.0%)patients were 13-36 months old,and 12(17.1%)patients were over 36 months old.(2)The average onset time of severe pneumonia induced by Adv-7 was(11.87±7.10)days before being admitted to PICU.The average sequential organ failure assessment score was 6.80±3.13.The average Murray lung injury score was 2.49±1.15.The average P/F value was(150.57±86.25)mmHg(1 mmHg=0.133 kPa).Sixty-four cases(91.4%)were involved in two or more area of lung on X-rays.All cases were diagnosed with sepsis.(3)Laboratory examination:white blood cell count was(7.6±5.5)×10^9/L,platelet count was(238.8±164.2)×10^9/L,and C-reactive protein was(39.4±37.2)mg/L.(4)Treatments:intravenous gamma globulin was used in 65 cases(92.9%).Intravenous glucocorticoid was used in 45 cases(64.3%).Fiberoptic bronchoscopy was performed in 43 cases(61.4%).Blood purification treatment was performed in 21 cases(30%).Sixty-three patients(90.0%)were treated with non-invasive or invasive ventilator,high frequency ventilator-assisted ventilation was used in 20 cases(28.6%).Surfactant was used in six cases(8.6%).Extracorporeal membrane oxygenation was used in 19 cases(27.1%).(5)The average treatment time for ventilation was(13.10±11.58)days.The average time for temperature recover was(4.69±4.01)days in PICU.The average PICU stay time was(15.76±12.20)days.The average length of stay was(27.04±13.10)days.There were 16 patients died and the mortality was 22.9%.Conclusion The children with severe pneumonia induced by Adv-7 were critical and had

关 键 词：重症腺病毒肺炎 7型腺病毒 脓毒症 体外膜肺氧合 

分 类 号：R725.6[医药卫生—儿科]