需机械通气的儿童重症博卡病毒肺炎十例临床分析  

Retrospective analysis of ten patients with severe human Boca virus pneumonia required mechanical ventilation

作　　者：刘霜君 霍枫[1] 刘珺[2] 范祎慕 张哲哲[1] 刘潇[1] 王硕 武洁[1] 王荃[2] Liu Shuangjun;Huo Feng;Liu Jun;Fan Yimu;Zhang Zhezhe;Liu Xiao;Wang Shuo';Wu Jie;Wang Quan(Department of Emergency,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Pediatric Intensive Care Unit,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院急诊科,100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院重症医学科,100045

出　　处：《中国小儿急救医学》2024年第6期449-454,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的总结因博卡病毒感染需机械通气的重症肺炎儿童的临床特点。方法回顾性分析2022年10月至2023年6月入住首都医科大学附属北京儿童医院急诊重症监护病房需机械通气的重症博卡病毒肺炎患儿的临床资料。结果共纳入10例需机械通气的重症博卡病毒肺炎患儿,其中男7例,中位年龄21.5(10.0~42.0)个月,6例患儿<2岁。6例患儿于2022年秋季入院,4例患儿于2023年夏季入院。10例患儿均有咳嗽、喘息、发热。10例患儿入院查体均可闻及哮鸣音;6例患儿呼吸音减低,2例可闻及湿啰音。2例患儿合并鹅口疮,1例患儿支气管肺泡灌洗液培养可见肺炎链球菌及金黄色葡萄球菌,1例患儿病程第5天检出人疱疹病毒6型感染,1例患儿检出鼻病毒。余5例患儿无合并感染证据。所有患儿均因呼吸衰竭予有创机械通气,机械通气中位时间为85(46~165)h。每例患儿行1~3次电子支气管镜检查及治疗,镜下表现为气管支气管内膜炎症、黏膜明显肿胀、分泌物增多(10/10),黏液栓形成(8/10)以及散在坏死上皮附着(4/10)。所有患儿好转后出院,中位住院时间9(6~14)d。结论博卡病毒是儿童重症肺炎的重要病原体之一,以严重咳喘、发热为主要表现,可导致气管支气管内膜炎症,易形成黏液栓和黏膜坏死,重者需机械通气及支气管镜治疗,多数预后良好。Objective To summarize the clinical characteristics of children with severe pneumonia requiring mechanical ventilation due to human Boca virus infection.Methods Clinical data of children with severe human Boca virus pneumonia required mechanical ventilation who were admitted to the emergency intensive care unit at Beijing Children's Hospital Affiliated to Capital Medical University from October 2022 to June 2023 were retrospectively analyzed.Results A total of ten children with human Boca virus pneumonia required mechanical ventilation were included,including seven males with a median age of 21.5(10.0-42.0)months and six children less than two years old.Six patients were admitted to hospital in the fall of 2022 and four were in the summer of 2023.All cases had cough,wheezing and fever.The wheezes could be heard in all patients admitted to hospital for physical examination.Respiratory sounds were reduced in six cases,and moist crackles were heard in two cases.Two patients had thrush.One patient with bronchial lavage culture showed streptococcus pneumoniae and staphylococcus aureus.One patient had human herpesvirus type 6 infection on day 5 of the course of disease,and one child had rhinovirus.There was no evidence of co-infection in the remaining five cases.All patients were given mechanical ventilation for respiratory failure,and the median mechanical ventilation time was 85(46-165)hours.Each patient was examined by bronchoscope for 1-3 times.Bronchoscopy manifested endobronchial inflammation,mucosal swelling,increased secretions(10/10),mucous thrombus formation(8/10)and scattered necrotic epithelium(4/10).All patients were discharged after improvement and the median length of administration was 9(6-14)days.Conclusion Human Boca virus is one of the important pathogens of severe pneumonia in children,with severe cough,wheezing and feve,which can lead to endobronchial trachea inflammation,easy to form mucous embolus and mucosal necrosis.In severe cases,mechanical ventilation and bronchoscopy are required,and most o

关 键 词：机械通气 博卡病毒 重症肺炎 

分 类 号：R725.6[医药卫生—儿科]