摘要
目的总结儿童坏死性肺炎(NP)的临床特点、诊治方法及转归,以提高对NP的认识。方法选取2012年12月至2020年6月在湖南省人民医院儿童医学中心确诊为NP的患儿,根据是否行呼吸支持分为呼吸支持组9例和非呼吸支持组27例;根据是否合并胸腔积液分为胸腔积液组28例和非胸腔积液组8例,收集所有患儿的临床资料,并比较不同组间的差异。结果36例NP患儿,男14例,女22例,中位年龄30(12,49)个月,病程34(25,42)d。所有患儿均有咳嗽,34例有发热,热峰39.5(39.1,40.0)℃。实验室检查(均为峰值)血白细胞计数20.77(15.65,28.35)×10^(9)/L,中性粒细胞计数15.11(8.52,20.65)×10^(9)/L,C-反应蛋白(CRP)104.00(23.45,146.50)mg/L,D-二聚体5.12(1.88,8.04)mg/L,乳酸脱氢酶(LDH)347.95(284.68,447.81)U/L。病原检出率为58.33%(21/36),以金黄色葡萄球菌最常见(28.57%,6/21)。8例患儿行手术治疗,其中5例行胸腔镜手术,3例行开胸手术。所有患儿均好转出院。呼吸支持组与非呼吸支持组患儿的住院时间、白细胞计数、CRP、降钙素原及LDH比较,胸腔积液组与非胸腔积液组的中位年龄、白细胞计数、CRP、D-二聚体及LDH比较,差异均有统计学意义(P均<0.05)。进一步行多因素Logistic回归分析显示,LDH是NP行呼吸支持的危险因素(P<0.05),ROC曲线下LDH面积为0.802,cut-off值为471.21 U/L;胸腔积液组与非胸腔积液组患儿的各项指标差异无统计学意义。结论儿童NP患者易出现反复高热,炎症指标高,病程长,其病原以金黄色葡萄球菌较为常见。血清LDH≥471.21 U/L是NP行呼吸支持的早期独立预测指标。
Objective To summarize the clinical features,diagnosis,treatment,and outcomes of necrotizing pneumonia(NP)in children,so as to improve the understanding of NP.Methods Children with NP admitted to the Children′s Medical Center of Hunan Provincial People′s Hospital from December 2012 to June 2020 were selected and divided into respiratory support group(nine cases)and non-respiratory support group(27 cases)according to whether they received respiratory support;and they were also divided into pleural effusion group(28 cases)and non-pleural effusion group(eight cases)according to whether combined with pleural effusion.The clinical data of all children were collected,and the differences between different groups were compared.Results There were thirty-six children with NP,included 14 boys and 22 girls,with a median age of 30(12,49)months,and the disease duration was 34(25,42)days.All children had cough,34 cases had fever,and the fever peak was 39.5(39.1,40.0)℃.Laboratory tests(all peaks)showed that blood white blood cell count was 20.77(15.65,28.35)×10^(9)/L,neutrophil count was 15.11(8.52,20.65)×10^(9)/L,C-reactive protein(CRP)was 104.00(23.45,146.50)mg/L,D-dimer was 5.12(1.88,8.04)mg/L,and lactate dehydrogenase(LDH)was 347.95(284.68,447.81)U/L.The detection rate of pathogens was 58.33%(21/36),and the most common was Staphylococcus aureus(28.57%,6/21).Eight cases underwent surgical treatment,including five cases of thoracoscopic surgery and three cases of thoracotomy.All patients improved and were discharged from hospital.The differences in hospital stay,white blood cell count,CRP,procalcitonin and LDH levels between respiratory support group and non-respiratory support group were statistically significant,and the median age,white blood cell count,CRP,D-dimer and LDH between pleural effusion group and non-pleural effusion group were statistically significant(all P<0.05).Further multivariate Logistic regression analysis showed that LDH was a risk factor for NP children receiving respiratory support(P<0.05),the a
作者
黄倩
曾赛珍
陈玲玲
谌艳梅
吴佩
祝益民
Huang Qian;Zeng Saizhen;Chen Lingling;Shen Yanmei;Wu Pei;Zhu Yimin(Pediatric Medical Center,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People′s Hospital),Changsha 410000,China;Hunan Institute of Emergency Medicine,Changsha 410000,China)
出处
《中国小儿急救医学》
CAS
2023年第2期115-121,共7页
Chinese Pediatric Emergency Medicine
基金
湖南省儿童呼吸疾病重点实验室项目(2019TP1043)
长沙市科技局项目(kq2004116)。
关键词
坏死性肺炎
预测指标
胸腔积液
儿童
Necrotizing pneumonia
Predictor
Pleural effusion
Children
