东莞市1275例儿童重症肺炎的病原学及临床特点分析

Etiology and Clinical Characteristics of 1275 Children with Severe Pneumonia in Dongguan City

目的:分析东莞市儿童重症肺炎的病原学及临床特点,为临床诊治提供参考依据。方法:回顾性分析2018年1月—2022年12月东莞市妇幼保健院收治的1275例儿童重症肺炎的病原检测、影像学资料、临床诊治及预后等资料。结果:1275例重症肺炎以≤1岁的婴儿为主(56.7%),夏季(26.35%)及秋季(31.22%)高发。主要临床表现为发热、咳嗽、气促、喘息、发绀,合并心肺基础疾病者多见。病原检测以细菌感染(21.7%)及非典型病原体感染(21.3%)为主,检出病原前五位为:肺炎支原体、呼吸道合胞病毒、流感嗜血杆菌、肺炎链球菌、腺病毒。98例儿童出现肺实变,48例胸腔积液,肺实变以细菌及混合感染为主,胸腔积液以肺炎支原体感染最常见。药物治疗包括应用抗生素(83.0%)、甲泼尼龙琥珀酸钠治疗(22.4%)、免疫球蛋白治疗(8.4%)等,机械通气211例(16.54%),机械通气以病毒及混合感染常见,非典型病原感染最少。结论:东莞地区儿童重症肺炎好发于1岁以下婴儿,夏、秋季节高发,以细菌及非典型病原感染为主,最常见感染病原为肺炎支原体、呼吸道合胞病毒、流感嗜血杆菌等,<3个月龄小婴儿以呼吸道合胞病毒感染最常见,3个月~1岁婴儿以呼吸道合胞病毒及流感嗜血杆菌感染为主,1岁以上儿童以肺炎支原体感染最常见,肺炎支原体感染易合并胸腔积液,病毒及混合感染易出现呼吸衰竭。

Objective:To analyze the etiology and clinical characteristics of severe pneumonia in children in Dongguan City,and to provide reference for clinical diagnosis and treatment.Methods:The pathogen detection,imaging data,clinical diagnosis and prognosis of 1275 children with severe pneumonia admitted to the hospital from January 2018 to December 2022 were retrospectively analyzed.Results:The majority of 1275 cases of severe pneumonia were infants<1 year old(56.7%),with the highest incidence in summer(26.35%)and autumn(31.22%).The main clinical manifestations of fever,cough,shortness of breath,wheezing,cyanosis,and combined with cardiopulmonary diseases were more common.Bacterial infection(21.7%)and atypical pathogen infection(21.3%)were the main pathogens detected.The top 5 pathogens detected were mycoplasma pneumoniae,respiratory syncytial virus,haemophilus influenzae,streptococcus pneumoniae and adenovirus.There were 98 cases of lung consolidation and 48 cases of pleural effusion.The main cases of lung consolidation were bacterial and mixed infection,and the most common pleural effusion was mycoplasma pneumoniae infection.Drug treatment included antibiotics(83.0%),methylprednisolone sodium succinate(22.4%),immunoglobulin(8.4%),etc.211 cases(16.54%)were treated with mechanical ventilation.Virus and mixed infection were common in mechanical ventilation,and atypical pathogen infection was the least.Conclusion:Severe pneumonia in children in Dongguan is most likely to occur in infants under<1 year old,with a high incidence in summer and autumn.It is mainly caused by bacterial and atypical pathogens,and the most common pathogens are mycoplasma pneumoniae,respiratory syncytial virus and haemophilus influenzae,etc.Respiratory syncytial virus is the most common infection in infants of<3 months old.Respiratory syncytial virus and haemophilus influenza are the most common infections in infants aged 3 months~1 years old,and mycoplasma pneumoniae is the most common infection in children>1 year old.Mycoplasma pneumoniae is more likely to be combined with pleural effusion,and viral and mixed infections are more likely to lead to respiratory failure.