摘要
目的分析重症腺病毒肺炎(SAP)患儿临床特点。方法 2011年1月至2014年4月广州市妇女儿童医疗中心重症监护室诊断为重症腺病毒肺炎患儿37例。分析重症腺病毒肺炎患儿临床特点、影像学特点、实验室检查、治疗方法及转归。结果 37例重症腺病毒肺炎患儿,男女比例为3.1∶1,2岁以下发病达31例,夏秋季发病共27例,所有患儿均有发热及咳嗽表现,其中并发呼吸衰竭29例,急性呼吸窘迫综合征(ARDS)26例,塑型性支气管炎4例,气胸5例,脓毒症休克26例,多器官功能障碍(MODS)26例。29例予气管插管机械通气,20例行纤维支气管镜灌洗,4例因合并严重脓毒症休克及急性肾损伤行床旁连续性血液净化(CBP)治疗。死亡患儿共6例,死亡组的乳酸脱氢酶、门冬氨酸转氨酶、危重症评分(PCIS)、肺叶受累数量、并发症种类较生存组显著升高,血小板、白蛋白、P/F比值较生存组显著降低,(P均<0.05)。结论重症腺病毒肺炎临床表现重,易合并多种并发症,为早期明确诊断,建议尽早完善病原学,积极行肺CT检查,出现低氧血症时尽早机械通气,合并肺不张时行纤支镜灌洗有助于改善通气,出现急性肾损伤时可采取血液净化等综合治疗。
Objective To analyze the clinical characteristics of severe adenovirus pneumonia （SAP） in pediatric patients. Methods Totally 37 pediatric patients with SAP were reported. All data were collected from cases who were hospitalized in the Department of PICU Guangzhou Women and Children＇ s Medical Center hospital from January 2011 to April 2014, and clinical manifestations, changes in i mageology, laboratory examination, therapeutic methods and treatment responses were analyzed. Results Among 37 patients, 3 lchildren were aged blow 2 years, with a male to female ratio of 3.1 ： 1. The onset of 27patients was in summer and autumn.All patients had fever and cough ; all cases had complications, including 29 with respiratory failure, 26 with acute respiratory distress syndrome （ARDS）, 4 with plastic bronchitis, 5 with pneumothorax, 26 with sepsis shock, and 26 with multiple organ dysfunction syndrome （MODS）. Totally 29 patients were ventilated, 20 were explored by flexible-brenchoscopy, and 4 patients with sever sepsis and acute kidney injury were treated with continuous blood purification （ CBP ）. Six patients died; levels of LDH, AST, pediatric critical illness score （PCIS）, number of the lung labors involved and number of complications in death group were more than in survival group, while number of platelet and levels of albumin were less than survival group, the difference being significant （P 〈 0.05）. Conclusion SAP is a severe pneumonia with severe clinical manifestations and many complications. It is recommended to complete etiological and chest radiographic examination for early diagnosis. It is also recommended to ventilate when children present with hypoxemia as soon as possible. Performing fiber bronchoscope will help to improve ventilation when children develop pulmonary atelectasis. Blood purification should be performed when children have acute kidney injury.
出处
《中国实用儿科杂志》
CSCD
北大核心
2015年第9期691-695,共5页
Chinese Journal of Practical Pediatrics
关键词
重症肺炎
腺病毒
儿童
急性呼吸窘迫综合征
连续血液净化
severe pneumonia
adenovirus
child
acute respiratory distress syndrome
continuous blood purification
