呼吸系统疾病专栏

肺炎并肺不张690例病原学分析

  • 李悦菡 ,
  • 刘铮 ,
  • 符州 ,
  • 杨志梅
展开
  • 重庆医科大学附属儿童医院呼吸科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆 400014)

收稿日期: 2021-05-13

  网络出版日期: 2022-04-07

基金资助

重庆英才计划创新领军人才项目

Etiological analysis of 690 cases of pneumonia complicated with atelectasis

  • Yuehan LI ,
  • Zheng LIU ,
  • Zhou FU ,
  • Zhimei YANG
Expand
  • Department of Respiratory Diseases, Children's Hospital of Chongqing Medical University, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China

Received date: 2021-05-13

  Online published: 2022-04-07

摘要

目的 研究重庆地区肺炎并肺不张的病原学特点。方法 收集690例肺炎并肺不张患儿的临床资料,回顾性分析其病原、受累肺叶、支气管肺泡灌洗的疗效等。结果 690例患儿中男353例、女337例,中位年龄4.1(2.5~6.8)岁。其中病原明确者 601例(87.1%),感染病原以肺炎支原体最常见(330例,47.8%),其次为细菌(271例,39.3%)和病毒(209例,30.3%)。不同年龄组、不同季节组之间病原体分布差异有统计学意义(P<0.001)。婴儿组与幼儿组细菌、病毒以及细菌+病毒混合感染的比例均较高,学龄前期和学龄期支原体感染比例较高;春、秋季细菌感染比例较高,冬季病毒感染比例较高,夏、秋季支原体感染比例较高。不同年龄段之间患儿肺炎并肺不张的好发部位差异有统计学意义(P<0.001)。婴儿组右肺上叶肺不张比例较高,幼儿、学龄前期和学龄组右肺中叶肺不张比例较高。支气管肺泡灌洗次数与病原种类、受累肺叶数量有相关性(P<0.01),单病原组以及单叶肺不张组灌洗次数为1次的比例较高。结论 肺炎并肺不张的病原以肺炎支原体最常见,各年龄段、各季节之间病原组成存在差异,受累肺叶以右肺中叶常见,预后与病原体种类、受累肺叶数量密切相关,混合感染、多叶肺不张易导致难治性肺不张。

本文引用格式

李悦菡 , 刘铮 , 符州 , 杨志梅 . 肺炎并肺不张690例病原学分析[J]. 临床儿科杂志, 2022 , 40(4) : 268 -273 . DOI: 10.12372/jcp.2022.21e0706

Abstract

Objective To study the etiological characteristics of pneumonia complicated with atelectasis in the city of Chongqing.Methods The clinical data of 690 children with pneumonia complicated with atelectasis were collected, and a retrospective analysis was performed on the characteristics of pathogen, involved lobes and the clinical effect of bronchoalveolar lavage.Results A total of 690 children (353 boys and 337 girls) were included and the median age was 4.1 (2.5~6.8) years. Among them, 601 children (87.1%) had definite pathogens. Mycoplasma pneumoniae was the commonest pathogen (330 cases, 47.8%), followed by bacteria (271 cases, 39.3%) and virus (209 cases, 30.3%). There were significant differences in pathogen distribution among different age groups and different season groups (P<0.001). The proportion of bacteria, virus and bacteria combined with virus infection was higher in infant and young children group. The proportion of mycoplasma infection was higher in preschool and school-age children. The proportion of bacterial infection was higher in spring and autumn, that of virus infection was higher in winter, and that of mycoplasma infection was higher in summer and autumn. There were statistically significant differences in the predisposition sites of pneumonia with atelectasis among different age groups (P<0.001). The proportion of atelectasis in the upper lobe of the right lung was higher in the infant group, and that in the middle lobe of the right lung was higher in the young children, pre-school age and school age groups. The frequency of bronchoalveolar lavage was significantly correlated with the type of pathogen and the number of affected lobes (P<0.01). The proportion of one time of bronchoalveolar lavage in children with single pathogen infection and single lobe atelectasis was high.Conclusions Mycoplasma pneumoniae is the commonest pathogen of pneumonia complicated with atelectasis, and there are differences in pathogen composition among different ages and seasons. The main involved lobe is the right middle lobe. The prognosis is closely related to the pathogen of infection and the number of affected lobes, and refractory atelectasis is easily caused by mixed infection and multilobed atelectasis.

参考文献

[1] Dash S, Chaudhry R, Dhawan B, et al. Clinical spectrum and diagnostic yields of Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia[J]. J Lab Physicians, 2018, 10(1):44-49.
[2] Talamoni HL, Pisapia ND, Buendía JA, et al. Flexible fiberoptic bronchoscopy in children with persistent atelectasis: a case series report[J]. Arch Argent Pediatr, 2015, 113(2):106-108.
[3] 胡亚美, 江载芳, 申昆玲. 诸福棠实用儿科学 [M]. 8版. 北京: 人民卫生出版社, 2015: 1256-1258.
[4] Lee CY, Huang YY, Huang FL, et al. Mycoplasma pneumoniae-associated cerebral infarction in a child[J]. J Trop Pediatr, 2009, 55(4):272-275.
[5] Duggan M, McNamara PJ, Engelberts D, et al. Oxygen attenuates atelectasis-induced injury in the in vivo rat lung[J]. Anesthesiology, 2005, 103(3):525-531.
[6] Choi YJ, Jeon JH, Oh JW, et al. Critical combination of initial markers for predicting refractory Mycoplasma pneumoniae pneumonia in children: a case control study[J]. Respir Res, 2019, 20(1):193.
[7] Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the respiratory tract and beyond[J]. Clin Microbiol Rev, 2017, 30(3):747-809.
[8] Kim YS, Lee YY, Lee E, et al. Cases of macrolide-resistant Mycoplasma pneumoniae pneumonia-associated pulmonary thromboembolism[J]. Pediatr Pulmonol, 2021, 56(6):1796-1799.
[9] Choi YH, Jeong HJ, Lee B, et al. Extensive and progressive cerebral infarction after Mycoplasma pneumoniae infection[J]. Korean J Crit Care Med, 2017, 32(2):211-217.
[10] 张丽君. 肺实变或肺不张肺炎支原体肺炎患儿气道黏液栓形成的危险因素及预后研究[D]. 石家庄: 河北医科大学, 2015.
[11] 梁磊, 杨泽玉, 王亚亭, 等. 纤维支气管镜术对小儿肺炎支原体肺炎合并肺不张的诊治作用[J]. 医学研究生学报, 2014, 27(4):401-404.
[12] Lou Q, Zhang SX, Yuan L, et al. Clinical analysis of adenovirus pneumonia with pulmonary consolidation and atelectasis in children[J]. J Int Med Res, 2021, 49(2): 300060521990244.
[13] Zhou Y, Wang J, Chen W, et al. Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia[J]. BMC Infect Dis, 2020, 20(1):633.
[14] Zhang X, Chen Z, Gu W, et al. Viral and bacterial co-infection in hospitalised children with refractory Mycoplasma pneumoniae pneumonia[J]. Epidemiol Infect, 2018, 146(11):1384-1388.
[15] Gao J, Xu L, Xu B, et al. Human adenovirus coinfection aggravates the severity of Mycoplasma pneumoniae pneumonia in children[J]. BMC Infect Dis, 2020, 20(1):420.
[16] 梁航. 502例儿童下呼吸道疾病纤维支气管镜检查的临床分析[D]. 长春: 吉林大学, 2010.
[17] 段晨敏, 刘远威, 胡明, 等. 儿童感染性肺不张肺泡灌洗液病原学分析[J]. 医学理论与实践, 2020, 33(6):959-961.
[18] 李晶, 岳学静, 郭喜霞, 等. 重症腺病毒肺炎患儿临床特征及CT诊断分析[J]. 中国CT和MRI杂志, 2019, 17(3):1-3.
[19] Dominguez MC, Alvares BR. Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects[J]. Radiol Bras, 2018, 51(1):20-25.
[20] Santos AK, Silveira J, Neves VC, et al. Atelectasis and lung changes in preterm neonates in the neonatal period: a blind radiological report and clinical findings[J]. Rev Bras Ter Intensiva, 2019, 31(3):347-353.
[21] 王崇杰, 耿刚, 李莹, 等. 支气管肺泡灌洗术治疗时机对重症支原体肺炎伴肺不张患儿影像学恢复的影响[J]. 重庆医科大学学报, 2019, 44(5):649-652.
[22] Escribano Montaner A, García de Lomas J, Villa Asensi JR, et al. Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain[J]. Eur J Pediatr, 2018, 177(2):181-192.
[23] Tschiedel E, Goralski A, Steinmann J, et al. Multiplex PCR of bronchoalveolar lavage fluid in children enhances the rate of pathogen detection[J]. BMC Pulm Med, 2019, 19(1):132.
[24] Marsh RL, Kaestli M, Chang AB, et al. The microbiota in bronchoalveolar lavage from young children with chronic lung disease includes taxa present in both the oropharynx and nasopharynx[J]. Microbiome, 2016, 4(1):37.
[25] 单玉霞, 崔振泽, 黄燕. 儿童感染性肺不张的临床分析[J]. 中国当代儿科杂志, 2014, 16(8):856-859.
[26] 林勇, 彭静君, 赵兴艳, 等, 应用纤维支气管镜诊断和治疗小儿肺不张的效果探讨[J]. 中国内镜杂志, 2019, 25(4):84-87.
[27] 龙婷文, 林继雷, 代继宏. 支气管肺泡灌洗术对肺炎支原体肺炎伴肺不张患儿治疗效果的影响因素分析[J]. 中国当代儿科杂志, 2020, 22(9):984-989.
[28] Li F, Zhu B, Xie G, et al. Effects of bronchoalveolar lavage on pediatric refractory Mycoplasma pneumoniae pneumonia complicated with atelectasis: a prospective case-control study[J]. Minerva Pediatr (Torino), 2021, 73(4):340-347.
[29] Thornby KA, Johnson A, Axtell S. Dornase alfa for non-cystic fibrosis pediatric pulmonary atelectasis[J]. Ann Pharmacother, 2014, 48(8):1040-1049.
文章导航

/