2020-2021年深圳市儿童医院儿童重症肺炎流行病学与临床特征分析

The epidemiological and clinical characteristics of severe pneumonia in children(2020-2021)

目的分析总结儿童重症肺炎的流行病学与临床特征,提高该病的诊治水平。方法回顾性分析2020年1月至2021年12月在深圳市儿童医院儿科重症监护病房(PICU)住院治疗的148例重症肺炎患儿的临床及胸部影像学资料。采集流行病学信息,对人口学特征、临床表现、实验室检查结果、影像学特点、并发症、治疗和预后数据进行总结。结果148例患儿中男79例(53.4%)、女69例(46.6%),发病年龄1月龄至17岁(中位月龄为12月龄),冬季发病57例(38.5%)。105例(70.9%)为单一病原体感染,43例(29.1%)为混合感染,前3位病原体依次为呼吸道合胞病毒、鼻病毒、铜绿假单胞菌。婴儿以呼吸道合胞病毒、鼻病毒感染为主,学龄期儿童以铜绿假单胞菌感染为主。108例(73.0%)合并基础疾病,咳嗽(73.0%)、喘息(65.5%)是最常见的呼吸道症状,低血压133例(89.9%)、低氧血症68例(45.9%)。超敏C反应蛋白、PCT和乳酸脱氢酶升高明显。患儿均有不同程度的肺段或肺叶炎症,以两肺下叶多见,伴有肺不张88例(59.5%),合并胸腔积液30例(20.3%)、脓胸4例(2.7%)、肺脓肿2例(1.4%),4例(2.7%)进展为坏死性肺炎。严重并发症包括脓毒症休克(11.5%)、急性呼吸窘迫综合征(7.4%)、多器官功能障碍综合征(MODS)(6.1%)等。78例(52.7%)需要呼吸机辅助通气,4例实施体外膜肺氧合(ECMO),11例(7.4%)死亡。重症肺炎死亡者合并脓毒症休克、急性呼吸窘迫综合征、MODS的比例显著高于存活者(P<0.05)。结论儿童重症肺炎以婴儿多见,婴儿流行病学呈夏、冬“双峰”特征;病原体以呼吸道合胞病毒、鼻病毒、铜绿假单胞菌感染为主。胸部影像学表现为多肺叶/段受累,以两肺下叶模糊片絮状或磨玻璃影改变最多见。合并基础疾病及脓毒症休克等时提示预后不良。

Objective To analyze and summarize the epidemiological and clinical characteristics of severe pneumonia in children,and to improve the diagnosis and treatment of this disease.Method Retrospectively analyzed the clinical and radiology data of 148 children with severe pneumonia,which were hospitalized in the pediatric intensive care unit(PICU)at Shenzhen Children's Hospital from January 2020 to December 2021.The epidemiological information was collected,and the demographic characteristics,clinical symptoms,laboratory results,imaging features,complications,treatment,and prognosis data were analyzed.Result There were 148 children,79(53.4%)males and 69(46.6%)females.The onset age ranged from 1 month to 17 years old(the median age was 12 months).Fifty-seven(38.5%)cases occurred in winter.One hundred and five cases(70.9%)were infected with a single pathogen,and 43 cases(29.1%)were infected with mixed pathogens.The top three pathogens were respiratory syncytial,rhinovirus,and pseudomonas aeruginosa.Respiratory syncytial virus and rhinovirus infections were mainly found in the infant group.Pseudomonas aeruginosa has the highest detection rate among school-age children.One hundred and eight cases(73.0%)had underlying diseases.The most common respiratory symptoms were cough(73.0%)and wheezing(65.5%).Hypotension was found in 133 cases(89.9%),and hypoxemia in 68 cases(45.9%).Hypersensitive C-reactive protein,procalcitonin,and lactate dehydrogenase increased.Variety extent segmental or lobular pneumonia were the common radiology findings,particularly in the lower lobe of the lungs.Atelectasis was found in eighty-eight cases(59.5%),pleural effusion was found in 30 cases(20.3%),empyema was found in 4 cases(2.7%),lung abscess was found in 2 cases(1.4%),and necrotizing pneumonia was found in 4 cases(2.7%).Severe complications included septic shock(11.5%),acute respiratory distress syndrome(7.4%),and multiple organ dysfunction syndrome(MODS)(6.1%).Seventy-eight cases(52.7%)required ventilator-assisted ventilation,4 cases were treated with extracorporeal membrane oxygenation(ECMO),and 11 cases(7.4%)died eventually.The proportion of deaths with severe pneumonia combined with septic shock,acute respiratory distress syndrome,and MODS was significantly higher than those who survived(P<0.05).Conclusion Severe pneumonia in children is more common in infants,and the epidemiology of the infant group is"double peaks"in summer and winter;the pathogens are mainly respiratory syncytial virus,rhinovirus and Pseudomonas aeruginosa infection.Chest imaging showed multiple lobes/segment involvement,with the most common changes in the density of the lower lobe of the lungs.Combined underlying diseases and septic shock suggest a poor prognosis.