临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (6): 443-.doi: 10.3969/j.issn.1000-3606.2020.06.010

• 综合报道 • 上一篇    下一篇

儿童吸入性肺炎164 例临床分析

熊丽梅,陈雯聪,代继宏   

  1. 重庆医科大学附属儿童医院呼吸科 儿科学重庆市重点实验室 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿童发育重大疾病国家国际科技合作基地(重庆 400014)
  • 出版日期:2020-06-15 发布日期:2020-06-12
  • 通讯作者: 代继宏 电子信箱:danieljh@163.com

Clinical analysis of aspiration pneumonia in 164 children

XIONG Limei, CHEN Wencong, DAI Jihong   

  1. Department of Respiratory, Children's Hospital of Chongqing Medical University; Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China
  • Online:2020-06-15 Published:2020-06-12

摘要: 目的 探讨儿童吸入性肺炎的临床特点及诊断要点。方法 回顾分析2013年1月1日至 2018年12月31日确 诊的164例住院吸入性肺炎患儿的临床资料。结果 164例患儿中,男性103例、女性61例,发病年龄29天~13岁,≤6岁 124例(75.6%);34例患儿有基础疾病,神经系统异常最常见(27例)。141例(86.0%)患儿有明确吸入史,淹溺是最常见病因; 23例(14.0%)无明确吸入史,但均合并神经系统异常或先天性上气道/消化道异常。常见临床症状为咳嗽、呼吸增快、发热、 意识障碍,79例(48.2%)患儿同时具有肺炎常见症状及肺部湿啰音。160例患儿行胸片或胸部CT检查,均提示肺炎,142例 双侧肺受累,中下肺为主。127例(77.4%)患儿行病原菌检查,共检出革兰阴性菌64株,革兰阳性菌24株,常见细菌为大肠 埃希菌(17株)、肺炎链球菌(17株)和流感嗜血杆菌(9株)。 所有患儿均使用抗生素治疗,142例好转,22例预后不良。结论 儿童吸入性肺炎临床表现复杂,吸入史、吸入风险评估及肺部影像学检查有助于疾病诊断。病原学检查有助于合理用药。

关键词: 儿童; 吸入性肺炎; 临床分析; 诊断; 病原学检查

Abstract:  Objective To explore the clinical characteristics and diagnosis of children's aspiration pneumonia. Method The clinical data of aspiration pneumonia in 164 hospitalized children from January 1, 2013 to December 31, 2018 were retrospectively analyzed. Results In 164 patients (103 boys and 61 girls) with the age at onset ranging from 29 days to 13 years, 124 patients (75.6%) were under 6 years old. Thirty-four children had underlying diseases and neurological abnormalities were the most common (27 cases). The history of inhalation was found in 141 (86.0%) children and drowning was the most common cause. There was no definite inhalation history in 23 children (14.0%), but all of them had neurological abnormalities or congenital upper airway/digestive tract abnormalities. The common clinical symptoms were cough, shortness of breath, fever and disturbance of consciousness. Only 79 cases (48.2%) had respiratory symptoms and lung rales simultaneously. Chest radiograph or chest CT examination in 160 cases indicated pneumonia, and 142 cases showed bilateral lung involvement, mainly middle and lower lung lobes. A total of 127 (77.4%) children were examined for pathogenic bacteria, and 64 strains were gram-negative bacteria and 24 strains were gram-positive bacteria. The common bacteria were Escherichia coli (17 strains), Streptococcus pneumoniae (17 strains) and Haemophilus influenza (9 strains). All patients treated by antibiotics and 142 recovered and 22 had poor prognosis. Conclusions The clinical manifestations of aspiration pneumonia in children are complex, and the history of inhalation, inhalation risk assessment, and lung imaging are helpful for the diagnosis. Etiological examination is helpful for rational use of drugs.

Key words: child; aspiration pneumonia; clinical analysis; diagnosis; etiological examination