儿童右中叶综合征的病原学分析及其肺功能变化

Etiology study and changes of pulmonary function tests of children with right lung middle lobe syndrome

目的:了解儿童右中叶综合征的主要病原类型及其治疗前后的肺功能变化。方法:应用电子支气管镜对临床诊断为右中叶综合征的儿童30例在局麻下进行支气管肺泡灌洗,取灌洗液做病原学的检测和分类;同时应用2600型和MIR型肺功能仪测定其在治疗前后的肺功能参数的变化。30例经临床和X线胸片、CT检查证实为右中叶综合征的患儿,按年龄分成两组,0～4岁组20例用2600型肺功能仪测定其在治疗前后的肺功能参数的变化,4岁以上组用MIR型肺功能仪测定其在治疗前后的肺功能参数的变化,2600型肺功能仪测定的主要参数取75%潮气量与最高呼气流速之比(25-PF)和潮气量与最高潮气呼气流速之比(%V-PF)2个参数来反映0～4岁组患儿的肺功能变化,MIR型肺功能仪测定的主要参数取最大肺活量(FVC)、1秒率(FEV1)和最高呼气流速(PEF)共3个参数来反映4岁以上组患儿的肺功能变化。结果:30例患儿中细菌阳性7例,占23.3%,病原分别为肺炎链球菌4例,肺炎克雷伯杆菌1例,大肠埃希杆菌1例,卡他莫拉菌1例;支原体3例,占10%,腺病毒3例,占10%,结核杆菌阳性1例,支气管异物2例,占6.7%,分别为花生和葵花籽。0～4岁组患儿治疗前肺功能参数的测定值分别为25-PF:(0.42±0.08),%V-PF:(0.28±0.03),治疗后的肺功能参数的测定值为25-PF:(0.58±0.12),%V-PF:(0.39±0.06),治疗前后比较,25-PF的t=4.21,P<0.05;%V-PF的t=3.82,P<0.05。4岁以上组患儿治疗前肺功能参数的测定值分别为FVC:(1.75±0.32),FEV1:(1.36±0.52),PEF:(2.56±0.78),治疗后的肺功能参数的测定值分别为FVC:(2.37±0.78),FEV1:(2.08±0.65),PEF:(3.68±0.80),治疗前后比较,FVC的t=3.05,P<0.05,FEV1的t=2.98,P<0.05,PEF的t=3.12,P<0.05。结论:儿童右中叶综合征的病因多种多样,有细菌、支原体、腺病毒、结核菌以及异物等,细菌是最主要的病原体,其中肺炎链球菌最多见;右中叶综合征的患儿治疗前后肺功能变化是明显的,治疗后中叶复张,炎症消失,肺功能恢复正常。

Objective：To analize the etiologic types of children with right lung middle lobe sysdrome（RLMLS） and to study the pulmonary function changes of children with RLMLS. nethods：Pathogerns of broncho-alveoli lavage fluids（BALF） from children with RLMLS were detected and classified with the utilization of electronic bronchoscope.30 children with RLMLS were selected by chest X-rays and CT examination.BALFs of patients were collected and divided into 3 tubes to do bacterial culture, virus seperation,smears microscopy and antibody detection of mycoplasma and chlamydia alternatively.In the same time,30 children with RLMLS were divided into 2 groups. Pulmonary function tests of which the 0-4 year old group were measured by 2600-type pulmonary function spirometry,while MIR-type pulmonary function spirometry being used for 〉4 years old group.The two parameters of 25-PF and %V-PF were selected as index for the 0-4 years old group to show the changes of Pulmonary function, while the three parameters of FVC, FEV~ and PEF being selected as index for the 〉4 years old group.The changes of these pulmonary function parameters were compared between pretreatment and posttreatment.Results：7 of 30 cases were bacteria positive,of which 4 cases being streptococcus pneumoniae, 1 case being clebsiella pneuminiae,1 case being escherichia coli,1 case being catarrh moraxella bacterium.3 of 30 cases mycoplasm-positive,3 of 30 cases being adcnovirusis,1 of 30 cases being tubercle bacillus,while 2 of 30 cases being foreign bodies whom were peanut and polly seed alternatively. Of 0-4 years old group the value of 25-PF was （0.42±0.08） for pretreatment and （0.58±0.12） for posttreatment respectively,the difference being significant（P〈0.05）,while the value of %V- PF being （0.28±0.03） for pretreatment and （0.39±0.06） for posttreatment respectively, the difference being significant also （P〈0.05）. Of〉4 years old group the values of FVC, FEV1 and PEF were （1.75±0.32）,（1.36±0.52）,（2.56±0.78） for pretreatment, while （2.37 ±0.78）, （2.08 ±0.65）, （3.68 ±0.80） for posttreatment respectively,the differences of FVC,FEV1 and PEF being significant respectively（P〈0.05）.Conclusion：The etiology of children＇s RLMLS varied from bacteria, adenovirus,mycoplasm, tubercle bacillu and foreign body.Bacteria were the main causes, of which streptococcus pneumoniae was the most important etiological cause. The changes of pulmonary function tests were significant between pretreatment and posttreatment for the children with RLMLS.