儿童肺不张支气管镜检和病原学分析

发布时间：2018-05-07 00:12

本文选题：肺不张 + 儿童　；参考：《重庆医科大学学报》2017年12期

【摘要】：目的:探讨肺不张儿童支气管镜下病变、支气管肺泡灌洗液病原学及两者之间的关系。方法:回顾性分析重庆医科大学附属儿童医院呼吸中心2011年12月至2016年6月确诊肺不张并行支气管镜检查患儿共412例,通过Chi-square with Yates'correction检验和Fisher精确检验比较不同部位肺不张镜下异常和检出病原的差异。结果:(1)肺不张前两位是右中叶不张(41.0%,169/412)和右上叶(40.7%,168/412),前者在3岁组检出率明显增高(115/223 vs.54/189,P=0.000),后者在≤3岁组检出率明显增高(110/189 vs.58/223,P=0.000)。支气管镜检异常155例,前三位为支气管狭窄85例(54.8%)、化脓性内膜炎45例(29.0%)、黏液栓21例(13.5%)。(2)支气管肺泡灌洗液病原检出240例(58.2%),其中细菌141例(34.2%)和肺炎支原体126例(30.5%)。鼻咽抽吸物病毒检出74例(18.0%)。(3)右中叶病变化脓性内膜炎32例(18.9%),化脓性内膜炎组肺炎链球菌检出较非化脓组明显增高(13/32 vs.24/137,P=0.009)。右上叶狭窄52例(31.0%),狭窄组肠杆菌科细菌检出率(15/52 vs.15/116,P=0.023)和早产儿率(16/52 vs.18/116,P=0.039)较非狭窄组明显增高。黏液栓组肺炎支原体检出率明显高于非黏液栓组(11/21vs.115/391,P=0.047)。结论:儿童肺不张部位与年龄有关。肺不张受累叶或段支气管可存在狭窄、化脓性内膜炎和黏液栓等病变,狭窄和化脓性内膜炎与细菌有关,黏液栓与肺炎支原体有关。
[Abstract]:Objective: to investigate the etiology of bronchoalveolar lavage fluid (BALF) in children with atelectasis. Methods: 412 children with atelectasis diagnosed by respiratory center of Children's Hospital affiliated to Chongqing Medical University from December 2011 to June 2016 were retrospectively analyzed. Chi-square with Yates'correction test and Fisher accurate test were used to compare the difference of abnormal and pathogenetic detection in different parts of atelectasis. Results (1) the first two cases of atelectasis were right middle lobe atelectasis (41.0 / 412) and right upper lobe (40.7 / 412). The positive rate of the former was significantly higher in the 3-year-old group than that in the 3-year-old group (115223 vs.54 / 189P ~ (0.000), and the detection rate of the latter was significantly higher than that of the 3-year-old group (110 / 189 vs.58-223P ~ (0.000). The first three cases were bronchial stenosis (85 cases, 54.8%), suppurative endocarditis (45 cases, 29. 0), mucohydrin, 21 cases (13. 5%), 240 cases of bronchoalveolar lavage fluid (BALF), including 141 cases of bacteria (34. 2%) and 126 cases of mycoplasma pneumoniae (30. 5%). 74 cases of nasopharynx aspiration virus were detected.) in right middle lobe lesions, 32 cases were suppurative endomatitis. The detection of Streptococcus pneumoniae in suppurative endomatitis group was significantly higher than that in non-purulent group (13% 32 vs.24% 137% P0. 009). In 52 cases of right upper lobe stenosis, the detection rate of Enterobacteriaceae bacteria in the stenosis group was 15 / 52 vs.15 / 116% P0. 023) and the rate of preterm infants was 16 / 52 vs.18 / 116 P0. 039) significantly higher than that in the non-stenosis group. The detection rate of mycoplasma pneumoniae in myxoembolus group was significantly higher than that in non-mucus suppository group. Conclusion: the location of atelectasis in children is related to age. Stenosis, suppurative endocarditis and mucus embolus may exist in the atelectasis of the affected lobes or segments of the bronchus. The stenosis and suppurative endocarditis are related to bacteria, and the myxoembolus is related to mycoplasma pneumoniae.
【作者单位】：重庆医科大学附属儿童医院礼嘉呼吸科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室;
【基金】：国家临床重点专科建设资助项目(编号:2011-873)
【分类号】：R725.6

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