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目的提高小儿大叶性肺炎合并肺脓肿的临床认识和诊疗水平。方法回顾性分析2013年7月至2014年6月黄石市爱康医院30例确诊为大叶性肺炎合并肺脓肿住院患儿的临床资料。结果发病年龄多为3~13岁,其中3~6岁者8例,7~14岁者22例,均有持续高热,最高体温达41℃,热程最长达10 d。咳嗽。均行胸部CT加三维重建检查:25例为单侧病变,其中右侧15例,左侧10例。合并肺膨胀不全10例,胸腔积液2例,胸膜粘连1例。22例肺炎支原体Ig M阳性,痰培养肺炎克雷伯菌5例,大肠埃希菌3例。金黄色葡萄球菌1例。结论对持续发热、超高热的儿童需早期及时行胸部CT加三维重维检查,有利于早期诊断、治疗及干预预后。治疗上应用大环内酯类抗生素及β-内酰胺类抗生素,必要时选用头孢四代及碳青酶烯类,足量雾化吸入,4次/d,健侧卧位,叩背排痰,3~4次/d,2 min/次,促进痰液排出,缩短病程,防止肺纤维化,影响肺部功能。
Objective To improve the clinical knowledge and diagnosis and treatment of lobar pneumonia complicated with pulmonary abscess in children. Methods The clinical data of 30 hospitalized patients diagnosed as lobar pneumonia with pulmonary abscess from July 2013 to June 2014 in Icahn Hospital of Huangshi City were retrospectively analyzed. Results The age of onset was mostly 3 to 13 years. Among them, 8 cases were from 3 to 6 years old and 22 cases were from 7 to 14 years old. All of them had sustained high fever, the highest temperature was 41 ℃ and the longest fever was 10 days. cough. Thoracic CT plus three-dimensional reconstruction were performed: 25 patients were unilateral lesions, of which 15 cases on the right and 10 cases on the left. 10 cases of pulmonary dysplasia, pleural effusion in 2 cases, pleural adhesions in 1 case. 22 cases of Mycoplasma pneumoniae IgM positive sputum culture Klebsiella pneumonia in 5 cases, 3 cases of Escherichia coli. Staphylococcus aureus in 1 case. Conclusions For children with persistent fever and hyperthermia, chest CT and three-dimensional multi-dimensional examinations should be performed early in time, which is good for early diagnosis, treatment and prognosis. Treatment of macrolide antibiotics and β-lactam antibiotics, if necessary, the choice of cephalosporins and carbon monoxide carbenoid, sufficient inhalation, 4 times / d, contralateral supine position, knock back Phlegm , 3 ~ 4 times / d, 2 min / times, to promote sputum discharge, shorten the course of disease, prevent pulmonary fibrosis, affect lung function.