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目的总结A族溶血性链球菌(GAS)坏死性肺炎(NP)患儿的临床表现及诊治特点。方法回顾分析北京儿童医院2008年4月至2012年4月住院的6例GASNP患儿临床及影像学表现、治疗及预后。结果 6例GAS中男女各3例,年龄2岁9个月至12岁6个月,均有高热及咳嗽,2例感染中毒症状明显。6例均有患侧呼吸音减低,均出现指趾端膜状脱皮。肺部影像学为肺大叶实变伴多发空腔,均合并胸腔积液,2例合并包裹性液气胸。外周血白细胞(11.48~41.42)×109/L,抗链球菌溶血素“O”试验(ASO)1例在正常范围,5例220~4355IU/L。其中3例行胸腔穿刺,胸腔积液检查提示:白细胞3930×106/L至满视野,多核细胞0.85~0.92,糖0.10~0.19mmol/L,蛋白42~55g/L,乳酸脱氢酶1313~5272IU/L;胸腔积液培养1例为化脓性链球菌,其余2例为无细菌生长。合并呼吸衰竭1例,感染性休克1例。均予抗炎治疗,2例行胸腔闭式引流术。6例均于临床症状控制、影像学表现好转后出院。结论 GAS感染可引起NP,重者合并呼吸衰竭和感染性休克,但经及时治疗后病情控制,预后良好。
Objective To summarize the clinical manifestations and diagnosis and treatment of children with Necrosis A pneumonia (GAS). Methods The clinical and imaging findings, treatment and prognosis of 6 children with GASNP hospitalized in Beijing Children’s Hospital from April 2008 to April 2012 were retrospectively analyzed. Results There were 3 males and 6 females in the 6 cases of GAS, ranging in age from 2 years old to 9 months to 12 years old and 6 months old. Both had fever and cough, and 2 cases had obvious symptoms of poisoning. 6 cases of ipsilateral respiratory sounds were reduced, there are finger to membrane dermabrasion. Lung imaging for the consolidation of large lobar lobe with multiple cavities, were combined pleural effusion, 2 cases of paroxysmal liquid pneumothorax. Peripheral white blood cells (11.48 ~ 41.42) × 109 / L, anti streptolysin “O ” test (ASO) in the normal range of 1 patients, 5 cases of 220 ~ 4355IU / Among them, thoracentesis and pleural effusion were found in 3 cases. The leukocyte count of 3930 × 106 / L to full field of view, multinucleated cells of 0.85 to 0.92, sugar of 0.10 to 0.19 mmol / L, protein of 42 to 55 g / L, lactate dehydrogenase of 1313 ~ 5272IU / L; 1 case of pleural effusion culture for Streptococcus pyogenes, the remaining 2 cases of bacterial growth. 1 case of respiratory failure, septic shock in 1 case. All were anti-inflammatory treatment, 2 cases closed thoracic drainage. 6 cases were controlled by clinical symptoms, imaging findings improved after discharge. Conclusion GAS infection can cause NP, severe respiratory failure and septic shock, but after the timely treatment of disease control, the prognosis is good.