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目的分析婴幼儿接种卡介苗(BCG)后淋巴结异常反应的原因与处理方法。方法对2004年1月-2010年9月间武汉市医疗救治中心收治的30例接种BCG后淋巴结异常反应的患儿临床资料进行回顾性分析。30例患儿均于接种BCG3~6个月后接种侧腋下及锁骨上淋巴结肿大,胸片与血沉正常,PPD试验(+),均无全身结核中毒症状。结果 20例淋巴结直径≤4 cm的患儿仅给予异烟肼口服或加环形封闭治疗2~3个月痊愈;另3例淋巴结>4 cm者行手术摘除。5例淋巴结化脓者在口服异烟肼治疗的同时,行穿刺抽脓、冲洗及并注入链霉素和异烟肼治疗,3~4周均痊愈。另2例有破溃者经切开排脓,冲洗、使用蘸有利福平粉的凡士林纱条引流及5%异烟肼软膏外敷治疗后痊愈。结论提高接种BCG的技术、接种质量和恰当处理BCG接种后的淋巴结异常反应,是预防与降低BCG接种后淋巴结异常反应发生率的关键措施。
Objective To analyze the causes and management of abnormal lymph node reaction after infancy BCG vaccination. Methods The clinical data of 30 children with abnormal postoperative lymph node response after BCG vaccination admitted to Wuhan Medical Treatment Center from January 2004 to September 2010 were analyzed retrospectively. All 30 infants had normal axillary and supraclavicular lymph nodes, normal thoracic and erythrocyte sedimentation rate, and PPD test (+) on the inoculation side 3 to 6 months after inoculation BCG. No symptoms of systemic tuberculosis were found. Results 20 cases of children with lymph node diameter ≤ 4 cm were treated with isoniazid orally or with ring-shaped block for 2 to 3 months, and 3 cases with lymph node> 4 cm were removed surgically. 5 cases of lymphatic purulent who were treated with isoniazid, puncture pus, irrigation and infusion of streptomycin and isoniazid, 3 to 4 weeks were cured. The other 2 cases had ruptured abscess, incision, use of Vaseline dipped with rifampicin gauze drainage and 5% isoniazid ointment after treatment cured. Conclusion Improving the technique of BCG inoculation, the quality of vaccination and proper treatment of abnormal lymph nodes after BCG inoculation are the key measures to prevent and reduce the incidence of abnormal lymph node reaction after BCG inoculation.