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目的:分析总结儿童坏死性肺炎(NP)的临床特征及诊治方法,以提高儿科临床对NP的诊疗水平。方法:回顾性分析2012年6月至2015年6月在自贡市第一人民医院接受治疗的47例NP患儿的临床资料,总结儿童NP的临床表现、影像学特征、病原学特点、治疗方法及预后。结果:47例患儿均表现出持续发热、咳嗽,部分伴有肺部湿啰音。病原学检查结果显示,11例细菌培养阳性(分别为肺炎链球菌5例、金黄色葡萄球菌2例、鲍曼不动杆菌2例、草绿色链球菌2例,其中7例合并肺炎支原体Ig M抗体阳性),35例细菌培养结果阴性(其中14例单纯肺炎支原体Ig M抗体阳性,9例单纯肺炎衣原体Ig M阳性,6例肺炎支原体Ig M抗体阳性合并肺炎衣原体Ig M抗体阳性,6例病原学检查结果均阴性),1例白假丝酵母菌培养阳性。胸部CT检查结果显示,所有患儿均可见多发性小空洞,16例合并胸腔积液。所有患儿均给予β-内酰胺类抗生素静脉滴注,并酌情给予头孢吡肟、美罗培南、利奈唑胺、万古霉素、阿奇霉素和(或)红霉素治疗,胸腔穿刺治疗16例,随访3~6个月,所有患儿均预后良好。结论:儿童NP可能与肺炎支原体(MP)或衣原体(CP)感染有关,但不能除外细菌感染,该病热程及病程较长,影像学表现明显,积极采取抗生素治疗可取得良好预后。
Objective: To analyze and summarize the clinical features and diagnosis and treatment of children with necrotizing pneumonia (NP) to improve the clinical diagnosis and treatment of NP. Methods: The clinical data of 47 NP patients treated in the First People’s Hospital of Zigong City from June 2012 to June 2015 were retrospectively analyzed. The clinical manifestations, imaging features, etiological characteristics and treatment of children with NP And prognosis. Results: All the 47 cases showed persistent fever and cough, some accompanied by pulmonary wet rales. Etiological examination showed that 11 cases of bacterial culture positive (respectively, 5 cases of Streptococcus pneumoniae, Staphylococcus aureus in 2 cases, Acinetobacter baumannii in 2 cases, Streptococcus viridans in 2 cases, of which 7 cases of Mycoplasma pneumoniae Ig M Antibody positive), 35 cases of bacterial culture negative (of which 14 cases of pure Mycoplasma pneumoniae IgM antibody positive, 9 cases of pure Chlamydia pneumoniae Ig M positive, 6 cases of Mycoplasma pneumoniae IgM positive with Chlamydia pneumoniae IgM antibody positive, 6 cases of pathogen School test results were negative), 1 case of Candida albicans culture positive. Chest CT examination showed that all children were seen multiple small holes, 16 cases of pleural effusion. All children were given β-lactam antibiotics intravenous infusion, and as appropriate cefepime, meropenem, linezolid, vancomycin, azithromycin and (or) erythromycin treatment, thoracentesis in 16 cases, followed up 3 to 6 months, all children have a good prognosis. Conclusion: NP in children may be related to the infection of Mycoplasma pneumoniae (MP) or Chlamydia (CP), but it can not be excluded except bacterial infection. The course of the disease is long and the imaging manifestations are obvious. Active antibiotic treatment can achieve a good prognosis.