泰安市中心醫院兒童大葉肺炎病原學特點及臨床分析

王兆輝　羅榮華　王緒棟

摘 要：目的 通過分析兒童大葉肺炎的病原學特點、臨床特征、治療效果及預后指導臨床工作。方法 對2017年1月～12月入住泰安市中心醫院兒內科的147例大葉肺炎患兒病原學特點、臨床特征及診療過程進行分析。結果 ①男性102例，女性45例，年齡4個月～13歲，平均年齡（3.47±4.17）歲，約占同期肺炎患兒的7.41%；全部病例均有咳嗽，伴發熱占91.83%；②存在合并癥共有27例，占18.37%，其中胸腔積液19例，胸膜炎24例，氣胸1例；③CRP、白細胞計數升高各占33.33%、23.81%；肺炎支原體抗體陽性占78.91%，血白細胞內EB病毒-DNA陽性占55.10%；④治療后發熱平均持續時間（4.60±1.57）d，復查胸部CT 123例完全吸收（83.67%），平均住院（9.40±2.17）d。結論 兒童大葉肺炎以學齡前及學齡期兒童為主，支原體感染占絕大多數，部分患兒合并細菌、EB病毒感染；癥狀不典型，多以發熱為首發癥狀，體征不明顯，并發癥多，經正規抗感染治療，患兒絕大多數均能痊愈。

關鍵詞：大葉肺炎；支原體；EB病毒

中圖分類號：R543 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.038

文章編號：1006-1959（2018）22-0133-03

Pathogenic and Clinical Analysis of Children's Lobar Pneumonia in Central Hospital of

Tai'an City

WANG Zhao-hui，LUO Rong-hua，WANG Xu-dong，SHEN Jing-jing，SUN Yan

（Department of Pediatrics，Tai'an Central Hospital，Tai'an 271000，Shandong，China）

Abstract：Objective To guide clinical work by analyzing the etiology， clinical features， treatment effects and prognosis of children with lobar pneumonia. Methods The pathogenic characteristics， clinical features and diagnosis and treatment of 147 children with lobar pneumonia admitted to the Department of Pediatrics of Tai'an Central Hospital from January to December 2017 were analyzed. Results ①Male 102 cases， female 45 cases， aged 4 months to 13 years， mean age （3.47±4.17） years old， accounting for 7.41% of children with pneumonia in the same period； all cases have cough， with fever accounted for 91.83%；②There were 27 cases of comorbidities， accounting for 18.37%， including 19 cases of pleural effusion， 24 cases of pleurisy， 1 case of pneumothorax； ③CRP， white blood cell count increased by 33.33%， 23.81%； Mycoplasma pneumoniae antibody accounted for 78.91%， blood Epstein-Barr virus-DNA positive in leukocytes accounted for 55.10%； ④Mean fever duration after treatment （4.60±1.57）d， 123 cases of chest CT were completely absorbed （83.67%）， and the average hospital stay （9.40±2.17）d. Conclusion Children with lobar pneumonia are mainly preschool and school-age children. Mycoplasma infection accounts for the majority. Some children have bacterial and EB virus infection. The symptoms are atypical. Most of them have fever as the first symptom， the signs are not obvious， and the complications are many. After regular anti-infective treatment， most of the children can be cured.

Key words：Lobar pneumonia；Mycoplasma；Epstein-Barr virus

大葉肺炎（lobar pneumonia）主要是由肺炎鏈球菌引起，病變累及一個肺段以上肺組織，以肺泡內彌漫性纖維素滲出為主的急性炎癥。典型臨床癥狀有突然寒戰、高熱、咳嗽、胸痛、咳鐵銹色痰。血白細胞計數增高；典型的X線表現為肺段、葉實變。但近年來，兒童大葉肺炎表現多不典型，常以發熱為唯一起病表現，后期出現咳嗽、咳痰等癥狀，且發病率有增高趨勢[1，2]，而病原也不以肺炎鏈球菌為主，故兒童大葉肺炎的診斷及治療有了新的特點。現就泰安市中心醫院兒科2017年1月～12月收治的147例兒童大葉肺炎的病原學特點及臨床特征和治療進行回顧性分析。……