临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (4): 334-.doi: 10.3969 j.issn.1000-3606.2015.04.010

• 综合报道 • 上一篇    下一篇

儿童社区获得性肺炎诊治研究

邢文亚,赵惠君   

  1. 上海交通大学医学院附属苏州九龙医院( 江苏苏州 215021)
  • 收稿日期:2015-04-15 出版日期:2015-04-15 发布日期:2015-04-15
  • 通讯作者: 赵惠君 E-mail:zhao-huijun@163.com

Research of the diagnosis and treatment of community-acquired pneumonia in children 

XING Wenya, ZHAO Huijun   

  1. Suzhou Jiulong Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Suzhou 215021, Jiangsu, China
  • Received:2015-04-15 Online:2015-04-15 Published:2015-04-15

摘要:  目的 探讨2013年儿童社区获得性肺炎(CAP)管理指南(简称2013版指南)应用于儿童CAP诊断和治疗中的思考与经验。方法 回顾性分析209例不同年龄儿童非重症CAP的临床特征,以及采用阿奇霉素为一线抗生素的治疗效果。结果 在209例患儿中,春夏季发病94例,秋冬季发病115例;51例(24.4%)患儿WBC计数≥10.0×109/L,91例(43.5%)患儿中性粒细胞绝对计数(ANC)≥5.0×109/L;199例(95.7%)患儿出现C反应蛋白(CRP)增高(≥3 mg/L);94例患儿MP-IgM阳性(45.0%)。173例(82.8%)患儿的胸片为单侧炎症病变,以右侧为多见。婴幼儿组、学龄前期组和学龄期组患儿之间发病季节(秋冬季和春夏季)的分布差异无统计学意义(P>0.05)。不同年龄组之间,WBC计数增高(≥10×109/L)比例的差异有统计学意义(P=0.002),以婴幼儿组比例为最高。MP-IgM阳性组患儿春夏季发病比例高于MP-IgM阴性组,差异有统计学意义(P<0.01)。以阿奇霉素作为一线抗生素的总有效率为98.1%(205/209),MP与非MP肺炎的总有效率的差异无统计学意义(P>0.05)。结论 2013版指南对儿童CAP的诊断和治疗有指导价值,但本地区儿童CAP也有其独特性。

Abstract: Objectives To summarize the application of Guidelines for the Management of Community-Acquired Pneumonia  (CAP) (2013 edition) in the diagnosis and treatment of children with CAP. Methods The clinical features of 209 children with non-severe CAP at different age stages were retrospectively analyzed. The curative effect of azythromycin was summarized which was used as first-line antibiotics in the CAP treatment. Results In 209 CAP children, the onset of 94 children was occurred in spring and summer and 115 occurred in autumn and winter. The white blood cell counts (WBC) in 51 CAP children (24.4%) were more than 10.0×109/L and absolute neutrophil counts (ANC) in 91 CAP children (43.5%) were more than 5.0×109/L. C-reactive protein levels in 199 CAP children (95.7%) were increased and MP-IgM showed positive in 94 CAP children (45.0%). 173 CAP children (82.8%) presented unilateral inflammatory lesions in chest X-ray, and the right side was predominant. There was no difference in onset season among different age groups (P>0.05). However, the percentage of WBC ≥ 10×109/L among different age groups were significantly different (P=0.002) and the percentage of WBC ≥ 10×109/L was highest in infants and young children group. The proportion of onset in spring and summer was significantly higher in MP-IgM positive group than that in MP-IgM negative group (P<0.01). The total effective rate of azithromycin used as first-line antibiotics was 98.1% (205/209), and there was no significant difference in total effective rate of azithromycin between MP and non-MP pneumonia groups. Conclusions  The Guidelines for the Management of CAP (2013 edition) have a reference value in the diagnosis and treatment of CAP in our region where the CAP in children has some different features.