肺炎并肺不张690例病原学分析

Etiological analysis of 690 cases of pneumonia complicated with atelectasis

目的研究重庆地区肺炎并肺不张的病原学特点。方法收集690例肺炎并肺不张患儿的临床资料,回顾性分析其病原、受累肺叶、支气管肺泡灌洗的疗效等。结果690例患儿中男353例、女337例,中位年龄4.1(2.5~6.8)岁。其中病原明确者601例(87.1%),感染病原以肺炎支原体最常见(330例,47.8%),其次为细菌(271例,39.3%)和病毒(209例,30.3%)。不同年龄组、不同季节组之间病原体分布差异有统计学意义(P<0.001)。婴儿组与幼儿组细菌、病毒以及细菌+病毒混合感染的比例均较高,学龄前期和学龄期支原体感染比例较高;春、秋季细菌感染比例较高,冬季病毒感染比例较高,夏、秋季支原体感染比例较高。不同年龄段之间患儿肺炎并肺不张的好发部位差异有统计学意义(P<0.001)。婴儿组右肺上叶肺不张比例较高,幼儿、学龄前期和学龄组右肺中叶肺不张比例较高。支气管肺泡灌洗次数与病原种类、受累肺叶数量有相关性(P<0.01),单病原组以及单叶肺不张组灌洗次数为1次的比例较高。结论肺炎并肺不张的病原以肺炎支原体最常见,各年龄段、各季节之间病原组成存在差异,受累肺叶以右肺中叶常见,预后与病原体种类、受累肺叶数量密切相关,混合感染、多叶肺不张易导致难治性肺不张。

Objective To study the etiological characteristics of pneumonia complicated with atelectasis in the city of Chongqing.Methods The clinical data of 690 children with pneumonia complicated with atelectasis were collected,and a retrospective analysis was performed on the characteristics of pathogen,involved lobes and the clinical effect of bronchoalveolar lavage.Results A total of 690 children(353 boys and 337 girls)were included and the median age was 4.1(2.5~6.8)years.Among them,601 children(87.1%)had definite pathogens.Mycoplasma pneumoniae was the commonest pathogen(330 cases,47.8%),followed by bacteria(271 cases,39.3%)and virus(209 cases,30.3%).There were significant differences in pathogen distribution among different age groups and different season groups(P<0.001).The proportion of bacteria,virus and bacteria combined with virus infection was higher in infant and young children group.The proportion of mycoplasma infection was higher in preschool and school-age children.The proportion of bacterial infection was higher in spring and autumn,that of virus infection was higher in winter,and that of mycoplasma infection was higher in summer and autumn.There were statistically significant differences in the predisposition sites of pneumonia with atelectasis among different age groups(P<0.001).The proportion of atelectasis in the upper lobe of the right lung was higher in the infant group,and that in the middle lobe of the right lung was higher in the young children,pre-school age and school age groups.The frequency of bronchoalveolar lavage was significantly correlated with the type of pathogen and the number of affected lobes(P<0.01).The proportion of one time of bronchoalveolar lavage in children with single pathogen infection and single lobe atelectasis was high.Conclusions Mycoplasma pneumoniae is the commonest pathogen of pneumonia complicated with atelectasis,and there are differences in pathogen composition among different ages and seasons.The main involved lobe is the right middle lobe.The prognosis is closely related to the pathogen of infection and the number of affected lobes,and refractory atelectasis is easily caused by mixed infection and multilobed atelectasis.