呼吸道黏液栓堵塞儿童大叶性肺炎临床分析

Clinical analysis of lobar pneumonia children with airway obstruction by mucus plug

目的探讨黏液栓堵塞呼吸道的儿童大叶性肺炎的临床特点。方法回顾性分析2016年10月至2017年8月郑州大学附属儿童医院呼吸科收治的81例大叶性肺炎患儿的临床资料,根据纤维支气管镜下情况分为堵塞组(分泌物黏稠、堵塞气管、吸引不易松动)33例和畅通组(分泌物较稀薄、未堵塞气管、经灌洗及吸引治疗气管通畅)48例,对比2组患儿的临床表现及血清C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体水平和病原体分布情况、临床疗效。结果堵塞组患儿发热33例(100.00%),其中稽留热12例(36.36%),不规则热21例(63.64%);畅通组患儿发热21例(43.75%),其中稽留热5例(10.41%),不规则热16例(33.33%);堵塞组患儿发热比例、稽留热和不规则热比例显著高于畅通组(χ~2=5.820、8.894、4.862,P<0.05)。堵塞组患儿的热程显著长于畅通组(t=9.978,P<0.05)。堵塞组患儿胸腔积液31例(93.94%),存在肺内并发症12例(36.36%);畅通组患儿胸腔积液18例(37.50%),无其他肺部并发症;堵塞组患儿胸腔积液率和肺内并发症发生率显著高于畅通组(χ~2=26.065、20.490,P<0.05)。堵塞组患儿血清CRP、PCT及D-二聚体水平均显著高于畅通组(P<0.05)。堵塞组患儿肺炎支原体感染22例(66.67%),细菌感染18例(54.54%),病毒感染4例(12.12%),混合感染16例(48.48%);畅通组肺炎支原体感染27例(56.25%),细菌感染12例(25.00%),病毒感染5例(10.42%),混合感染10例(20.83%);2组患儿肺炎支原体感染率、病毒感染率比较差异无统计学意义(χ~2=0.686、0.425,P>0.05);堵塞组患儿细菌感染率及混合感染发生率显著高于畅通组(χ~2=7.974、17.370,P<0.05)。治疗10 d后,畅通组和堵塞组患儿治疗有效率分别为100.00%(48/48)和63.64%(21/33);堵塞组患儿治疗有效率显著低于畅通组(χ~2=20.490,P<0.05)。结论黏液栓堵塞呼吸道的大叶性肺炎患儿热程更长,合并胸腔积液、肺内并发症比例高,CRP等血清指标水平高,病原学阳性检出率高,治疗有效率低。

Objective To investigate the clinical characteristics of lobar pneumonia children with airway obstruction by mucus plug.Methods The clinical data of 81 children with lobar pneumonia admitted to Children’s Hospital Affiliated to Zhengzhou University from October 2016 to August 2017 were retrospectively analyzed,and the children were divided into airway obstruction group(sticky secretion,blocking trachea,attracting and not easy to loosen)with 33 cases and airway unblocked group(dilute secretion,not blocking the trachea,Tracheal patency after lavage and aspiration)with 48 cases according to flexible bronchofiberscope examination.The clinical manifestations,pathogen distribution and clinical effect and the levels of serum C-reactive protein(CRP),procalcitonin(PCT)and D-dimer were compared between the two groups.Results There were 33 cases(100.00%)of fever,including 12 cases(36.36%)of continued fever and 21 cases(63.64%)of irregular fever in the airway obstruction group;there were 21 cases(43.75%)of fever,including 5 cases(10.41%)of continued fever and 16 cases(33.33%)of irregular fever in the airway unblocked group;the proportions of fever,continued fever and irregular fever in airway obstruction group were significantly higher than those in the airway unblocked group(χ~2=5.820,8.894,4.862;P<0.05).The fever duration in the airway obstruction group was significantly longer than that in the airway unblocked group(t=9.978,P<0.05).There were 31 cases(93.94%)of pleural effusion,including 12 cases(36.36%)of pulmonary complications in the airway obstruction group;there were 18 cases(37.50%)of pleural effusion without other pulmonary complications in the airway unblocked group;the incidences of pleural effusion and pulmonary complications in the airway obstruction group were significantly higher than those in the airway unblocked group(χ~2=26.065,20.490;P<0.05).The levels of serum CRP,PCT and D-dimer in the airway obstruction group were significantly higher than those in the airway unblocked group(P<0.05).There were 22 cases(66.67%)of mycoplasma pneumoniae infection,18 cases(54.54%)of bacterial infection and 4 cases(12.12%)of viral infection in the airway obstruction group,including 16 cases(48.49%)of mixed infection.There were 27 cases(56.25%)of mycoplasma pneumoniae infection,12 cases(25.00%)of bacterial infection and 5 cases(10.42%)of viral infection in the airway unblocked group,including 10 cases(20.83%)of mixed infection.There was no significant difference in the infection rate of mycoplasma pneumoniae and virus between the two groups(χ~2=0.686,0.425;P>0.05).The incidences of bacterial infection and mixed infection in the airway obstruction group were significantly higher than those in the airway unblocked group(χ~2=7.974,17.370;P<0.05).After 10 days of treatment,the effective rate in the airway obstruction group and the airway unblocked group was 63.64%(21/33)and 100.00%(48/48),respectively.The effective rate in the airway obstruction group was significantly lower than that in the airway unblocked group(χ~2=20.490,P<0.05).Conclusion The lobar pneumonia children with airway obstruction by mucus plug have the characteristics of long fever duration,high incidence of pleural effusion and pulmonary complications,high levels of serum indicators such as CRP,high positive detection rate of etiology and low treatment efficiency.