CAJ | 학술논문

目的探讨本院儿童重症肺炎病原体的检测情况.方法采用无菌培养基对痰液、静脉血标本进行细菌培养;间接免疫荧光法检测病毒、非典型病原体抗体,RT-PCR检测甲型H1N1流感病毒核酸.根据培养及药敏试验结果指导抗生素的使用,针对并发症进行抗炎、器官功能支持和其他个体化治疗.结果 123例患儿痰细菌培养阳性患儿69例(56.10％),其中革兰阴性菌50株(57.47％),革兰阳性菌37株(42.53％).革兰阴性菌主要为流感嗜血杆菌18株(20.96％)、大肠埃希菌13株(14.94％)、肺炎克雷白菌12株(13.79％);革兰阳性菌以金黄色葡萄球菌19株(21.84％)、肺炎链球菌14株(16.10％)为主.89例脓毒症患儿血培养阳性7例(8.00％).病毒感染11例,其中呼吸道合胞病毒抗体阳性2例,腺病毒抗体阳性2例,乙型流感病毒抗体阳性4例,副流感病毒抗体阳性2例,甲型H1N1流感病毒感染1例.肺炎支原体感染8例.123例患儿并发脓毒症89例(72.36％),呼吸衰竭85例(69.11％),胃肠功能障碍48例(39.02％),心力衰竭32例(26.02％),脓毒性休克18例(14.63％),中毒性脑病13例(10.57％),弥散性血管内凝血5例(4.07％),其中多器官功能障碍17例(13.82％).治愈46例(37.4％),好转出院73例(59.35％),死亡4例(3.25％),死亡病例均合并严重并发症.结论儿童重症肺炎病原体检出率高,不能忽略并发症的个体化救治,以提高救治成功率.
목적 탐토본원인동중증폐염병원체적검측정황.방법 채용무균배양기대담액、정맥혈표본진행세균배양;간접면역형광법검측병독、비전형병원체항체,RT-PCR검측갑형H1N1류감병독핵산.근거배양급약민시험결과지도항생소적사용,침대병발증진행항염、기관공능지지화기타개체화치료.결과 123례환인담세균배양양성환인69례(56.10％),기중혁란음성균50주(57.47％),혁란양성균37주(42.53％).혁란음성균주요위류감기혈간균18주(20.96％)、대장애희균13주(14.94％)、폐염극뢰백균12주(13.79％);혁란양성균이금황색포도구균19주(21.84％)、폐염련구균14주(16.10％)위주.89례농독증환인혈배양양성7례(8.00％).병독감염11례,기중호흡도합포병독항체양성2례,선병독항체양성2례,을형류감병독항체양성4례,부류감병독항체양성2례,갑형H1N1류감병독감염1례.폐염지원체감염8례.123례환인병발농독증89례(72.36％),호흡쇠갈85례(69.11％),위장공능장애48례(39.02％),심력쇠갈32례(26.02％),농독성휴극18례(14.63％),중독성뇌병13례(10.57％),미산성혈관내응혈5례(4.07％),기중다기관공능장애17례(13.82％).치유46례(37.4％),호전출원73례(59.35％),사망4례(3.25％),사망병례균합병엄중병발증.결론 인동중증폐염병원체검출솔고,불능홀략병발증적개체화구치,이제고구치성공솔.
Objective To discuss pathogens findings in children with severe pneumonia.Methods Bacteria was detected by using sputum culture and blood culture in sterile culture media.Viruses and atypical pathogenic antibodies were detected by using indirect immunofluorescence.Influenza A (H1N1) virus RNA were tested using RT-PCR.According to the results of bacterial culture and drug sensitive test,we can guide the use of antibiotics,and individualize treatment was carried out,including anti-inflammatory,organ function support.Results Bacteria was found in 69 children by using sputum culture.Gram negative bacteria accounted for 57.47％.Gram positive bacteria accounted for 42.53％.Escherichia coli(14.94％),Haemophilus influenzae (20.96％) and klebsiella pneumoniae(13.79％) were the main strains of Gram negative bacteria,Staphylococcus aureus (21.84％)and Streptococcus pneumonia(16.1％)were the main strains of Gram positive bacteria.Bacteria was found in 7 (8.00％) children by using blood culture.Virus were identified in 11 out of 123 patients,including 2 cases of respiratory syncytial virus antibody positive,2 cases of adenovirus antibodies positive,4 cases of influenza B virus antibody positive,2 cases of parainfluenza virus antibody positive and influenza A(H1N1) virus from only one case,Mycoplasma pneumonia agents were identified in 8 patients.Eighty-nine children (72.36％) complicated with sepsis,85 children (69.11％) with respiratory failure,48 children (39.02％) with gastrointestinal dysfunction,32 children (26.02％) with heart failure,18 children(14.63％) with septic shock,13 cases (10.57％) with toxic encephalopathy,5 children (4.07％) with disseminated intravascular coagulation.Among them,17 children (13.82％) complicated with multiple organ dysfunction syndrome.In the 123 children with severe pneumonia,46 cases (37.4％) were cured,73 cases (59.35％) improved,and 4 cases died (3.25％) with critical multiple organ dysfunction syndrome.Conclusion The detection rate of pathogen is high in this study.We should pay more attention to individualize therapy for complication,so that the cure rate could be increased.