CAJ | 학술논문

目的探讨儿童支原体肺炎并渗出性胸膜炎的临床特点,提高诊治水平.方法对2005年1月至2009年8月住院的32例支原体肺炎并渗出性胸膜炎患儿的临床资料进行回顾性分析.结果 32例患儿中,男22例,女10例;年龄5～12岁,平均(7.6±2.4)岁.主要临床表现为发热32例(100%),咳嗽32例(100%),胸痛2例(6.2%),喘息3例(9.4%);肺部阳性体征17例,主要表现为呼吸音降低14例,湿啰音3例,干啰音(含哮鸣音)3例;血常规示白细胞正常13例,(10～15)×109/L 14例,>15×109/L 5例,中性粒细胞占65%～78%;血清C-反应蛋白(正常<7 mg/L)正常5例,7～30 mg/L 12例,31～50 mg/L 8例,51～80 mg/L 6例,80 mg/L以上1例;血沉增快30例;结核菌素试验(PPD)均阴性;胸片均显示大叶性肺炎、胸膜炎改变,单纯右侧肺炎20例,左侧8例,双侧肺炎4例,均以下肺多见,胸腔积液32例,B超证实. 10例患儿行胸腔穿刺,胸水外观淡黄、清亮,细胞数(350～1020)×106/L,均以单核为主,蛋白定量25～38 g/L,腺苷脱氨酶(ADA)40～45 U, 血性胸水1例,细胞数1.6×109/L,单核78%,蛋白40 g/L,ADA 42 U;胸水病理检查均见大量淋巴细胞,未见肿瘤细胞.全部患儿予以大环内酯类抗生素抗感染,辅以化痰止咳等对症支持治疗均痊愈出院,住院时间3～4周,全部患儿出院时复查胸片及B超胸腔积液吸收,23例肺部病灶吸收,9例吸收好转,出院随访4～6周病灶吸收,1例患儿遗留肺不张.结论小儿支原体肺炎并渗出性胸膜炎好发于学龄儿童,经合理治疗大部分预后良好,病程约2～4周,少数遗留肺不张等后遗症.
목적 탐토인동지원체폐염병삼출성흉막염적림상특점,제고진치수평.방법 대2005년1월지2009년8월주원적32례지원체폐염병삼출성흉막염환인적림상자료진행회고성분석.결과 32례환인중,남22례,녀10례;년령5～12세,평균(7.6±2.4)세.주요림상표현위발열32례(100%),해수32례(100%),흉통2례(6.2%),천식3례(9.4%);폐부양성체정17례,주요표현위호흡음강저14례,습라음3례,간라음(함효명음)3례;혈상규시백세포정상13례,(10～15)×109/L 14례,>15×109/L 5례,중성립세포점65%～78%;혈청C-반응단백(정상<7 mg/L)정상5례,7～30 mg/L 12례,31～50 mg/L 8례,51～80 mg/L 6례,80 mg/L이상1례;혈침증쾌30례;결핵균소시험(PPD)균음성;흉편균현시대협성폐염、흉막염개변,단순우측폐염20례,좌측8례,쌍측폐염4례,균이하폐다견,흉강적액32례,B초증실. 10례환인행흉강천자,흉수외관담황、청량,세포수(350～1020)×106/L,균이단핵위주,단백정량25～38 g/L,선감탈안매(ADA)40～45 U, 혈성흉수1례,세포수1.6×109/L,단핵78%,단백40 g/L,ADA 42 U;흉수병리검사균견대량림파세포,미견종류세포.전부환인여이대배내지류항생소항감염,보이화담지해등대증지지치료균전유출원,주원시간3～4주,전부환인출원시복사흉편급B초흉강적액흡수,23례폐부병조흡수,9례흡수호전,출원수방4～6주병조흡수,1례환인유류폐불장.결론 소인지원체폐염병삼출성흉막염호발우학령인동,경합리치료대부분예후량호,병정약2～4주,소수유류폐불장등후유증.
Objective To investigate the clinical characteristics of children mycoplasma pneumonia complicated with exudative pleurisy and improve the diagnosis and treatment. Methods Thirty-two cases of mycoplasma pneumonia in children complicated with exudative pleurisy were analyzed retrospectively between January 2005 to August 2009. Results Thirty-two cases of children, the male 22 cases, female 10 cases; aged 5-12 years with a mean (7.6 ± 2.4) year. The main clinical manifestations were fever in 32 cases (100%), cough in 32 cases (100%), chest pain in 2 cases (6.25%), wheezing in 3 cases (9.1%);The positive signs of the lung in 17 cases, mainly for the breath sounds reduced in 14 cases, three cases of wet rale, dry rale (including wheezing sound) 3 cases;Routine blood test showed a normal white blood cells in 13 cases,(10-15)×109/L 14 cases,>15×109/L 5 cases, neutrophils accounted for 65%-78%;Serum CRP (normal 80 mg /L in 1 case;Increased ESR of 30 cases; PPD were negative;Chest X-ray have shown that lobar pneumonia, pleurisy change, just the right side of 20 cases of pneumonia, left 8 cases, bilateral pneumonia, 4 cases were more common following lung, pleural effusion in 32 cases, B super-confirmed.10 cases of children line the chest puncture, pleural effusion appearance of light yellow, clear, and cell count (350-1020)×106/L, are single-core-based, protein quantitative 25-38 g/L, ADA 40-45 U, bloody pleural effusion in 1 case, cell number of 1.6×109/L, single-core 78%, protein 40 g /L, ADA 42 U;Pleural effusion were seen in a large number of lymphocytes in pathological examination, no tumor cells.All patients to be macrolide antibiotic anti-infection, combined with symptomatic support therapy and were cured and discharged, length of stay 3-4 weeks, all children discharged from the hospital review and the B-pleural effusion chest X-ray absorption, 23 cases of pulmonary lesions absorption, absorption of 9 cases improved, discharge follow-up 4-6 weeks foci absorption and one cases of children with left lung atelectasis.Conclusions Mycoplasma pneumonia and exudative pleuritis occur in the school-age children, most of them with good prognosis after appropriate treatment, the course was about 2-4 weeks, a few left lung atelectasis or other consequences.