儿童大叶性肺炎67例临床分析

Clinical analysis of 67 cases of lobar pneumonia in children

[背景]分析儿童大叶性肺炎的临床特点.[病例报告]回顾性分析2018年1月—2020年3月间入院接受治疗的67例大叶性肺炎患儿的临床表现、病原学检测、实验室指标检查特点及影像学检查结果、临床治疗情况和住院时间.结果见,67例中临床表现为发热62例(92.5%),咳嗽67例(100.0%),憋喘5例(7.5%),肺部啰音22例(32.8%);病原学检测中肺炎支原体阳性41例(61.2%),病毒阳性5例(7.5%);实验室指标检查见,白细胞计数增高11例(16.4%),C反应蛋白增高42例(62.7%),降钙素原增高33例(49.3%);影像学检查见,肺炎范围累及右上叶4例(5.9%),右中叶1例(1.5%),右下叶11例(16.4%),左上叶7例(10.4%),左下叶5例(7.5%),右中上叶7例(10.4%),右中下叶8例(11.9%),左上、右中叶1例(1.5%),左上、右下叶4例(5.9%),左下、右上叶2例(2.9%),双下叶6例(8.9%),右中下叶合并右侧胸腔积液5例(7.5%),左上叶合并左侧胸腔积液2例(2.9%),双上叶合并左侧胸腔积液1例(1.5%),双下叶合并左侧胸腔积液1例(1.5%);临床治疗:单独给予抗生素治疗40例(59.7%),抗生素联合纤维支气管镜治疗27例(40.3%);住院时间5~14 d为57例(85.1%),14~20 d为10例(14.9%),白细胞、C反应蛋白及降钙素原水平增高患儿住院时间相对较长,抗生素联合支气管镜治疗患儿住院时间短于单独给予抗生素治疗患儿.[讨论]肺炎支原体为大叶性肺炎主要病原体,肺段或肺叶的受累部位主要集中于右下叶和右中下叶,白细胞、C反应蛋白及降钙素原升高的患儿病情相对较重,住院时间较长.

BACKGROUND To analyze the clinical characteristics of lobar pneumonia in children.CASE REPORTS Retrospective analysis was performed on the clinical manifestations,etiological tests,characteristics of laboratory indicators examination,imaging findings,clinical treatment and hospital stay of 67 children with lobar pneumonia admitted for treatment from January 2018 to March 2020.Among the 67 cases,the clinical manifestations were fever in 62 cases(92.5%),cough in 67 cases(100.0%),shortness of breath in 5 cases(7.5%),and rales in 22 cases(32.8%).Etiological test showed that mycoplasma pneumoniae was positive in 41 cases(61.2%),virus was positive in 5 cases(7.5%).Laboratory tests showed that leukocyte count increased in 11 cases(16.4%),C-reactive protein increased in 42 cases(62.7%),and procalcitonin increased in 33 cases(49.3%).Imaging findings showed that the pneumonia involved the right upper lobe in 4 cases(5.9%),the right middle lobe in 1 case(1.5%),the right lower lobe in 11 cases(16.4%)of,the left upper lobe in 7 cases(10.4%),and the left lower lobe in 5 cases of(7.5%),the right upper middle lobe in 7 cases(10.4%),the right middle lower lobe in 8 cases(11.9%),the left upper and right middle lobe in 1 case(1.5%),the left upper and right lower lobe in 4 cases(5.9%),the left lower and right upper lobe in 2 cases(2.9%),the double lower lobe in 6 cases(8.9%),and the pneumonia involved right middle and lower lobe combined with right pleural effusion in 5 cases(7.5%),the left upper lobe combined with left pleural effusion in 2 cases(2.9%),the double upper lobe combined with left pleural effusion in 1 case(1.5%),and the double lower lobe combined with left pleural effusion in 1 case(1.5%).40 cases(59.7%)were treated with antibiotics alone,27 cases(40.3%)were treated with antibiotics combined with fiberoptic bronchoscopy.The length of hospital stay was 5-14 d in 57 cases(85.1%),and 14-20 d in 10 cases(14.9%).Children with increased leukocytes,C-reactive protein and procalcitonin levels had a relatively long hospital stay,and children treated with antibiotics combined with bronchoscopy had a shorter hospital stay than those treated with antibiotics alone.DISCUSSION Mycoplasma pneumoniae is the main pathogen of lobar pneumonia.The affected parts of the lung segments or lobes are mainly concentrated in the right lower lobe and the right middle lower lobe.Children with elevated leukocytes,C-reactive protein and procalcitonin have a more serious condition and a longer hospital stay.