重庆地区76例以咯血为主要症状的儿童临床特点分析

发布时间：2019-01-26 15:39

【摘要】：目的分析重庆地区小儿咯血的临床特点,了解引起小儿咯血原因,结合病原学、影像学、纤维支气管镜等辅助检查结果,探讨小儿咯血诊断思路及治疗方案。方法回顾性分析2009年～2011年重庆医科大学附属儿童医院76例以咯血为主要症状的患儿的临床特点。结果 (1)本研究纳入2009年～2011年重庆医科大学附属儿童医院以咯血为主要症状的患儿76例,男女比例为1.2：1。最小年龄1月8天,最大16岁9月,平均年龄7.25±4.4岁。四季均有发病。 (2)76例患儿中咯血病因：最常见为感染性疾病,共51例(67.1%),其中肺炎30例(39.5%)(支原体肺炎1例),肺结核16例(21.1%),支气管炎5例(6.6%)；非感染性疾病以特发性肺含铁血黄素沉着症(idiopathic pulmonary hemosiderosis, IPH)最常见,明确诊断有3例(3.9%),另有8例疑诊IPH,其他原因可见鼻衄3例(3.9%),支气管扩张症1例(1.3%),咽部异物1例(1.3%),肺撕裂伤1例(1.3%),重症手足口病1例(1.3%)。另有14例病因不确定,其中疑诊肺结核4例。 (3)76例咯血患儿中,少量咯血66例(86.8%),其中表现为痰中带血29例(38.1%),中量咯血6例(7.9%),大量咯血4例(5.3%)；大量咯血患儿2例疑诊IPH,1例诊断肺结核,1例考虑呼吸道合并消化道出血。74例均伴有不同程度的咳嗽、咳痰症状,23例患儿伴随不同程度的发热。 (4)30例肺炎患儿痰培养常见细菌为肺炎链球菌(5例),卡他莫拉菌、流感嗜血杆菌和金黄色葡萄球菌各3例。16例结核病患儿结核菌素纯蛋白衍生物(purified protein derivative, PPD)试验阳性5例,通过病原学明确诊断9例,其中痰、空腹胃液涂片或培养找到抗酸杆菌7例,通过纤维支气管镜灌洗液涂片或培养找到抗酸杆菌2例。76例患儿中,可找到含铁血黄素巨噬细胞14例。完成纤维支气管镜检查者23例,均提示有急性或慢性气管支气管内膜炎,其中10例提示有不同部位支气管开口或管腔狭窄,2例可见陈旧性出血。76例咯血患儿中37例合并不同程度的贫血。 (5)76例患儿中52例使用止血药,其中6例使用垂体后叶素,一般止血用药为卡络磺、维生素K1、酚磺乙胺、血凝酶,用药后仅1例IPH患儿出院时仍有痰中带血,余患儿用药后咯血停止。24例患儿未使用止血药咯血可自行停止结论 (1)小儿咯血男女发病率无明显差异,发病年龄多见于5岁及13岁左右。 (2)感染性疾病是小儿咯血最常见原因,本组资料显示以肺炎最常见,其次是肺结核,另外支气管炎也可引起咯血。非感染性疾病以IPH最常见,支气管扩张症、异物是小儿咯血较少见原因。 (3)血液分析应作为咯血患儿常规检查。痰或胃液涂片找抗酸杆菌对确诊肺结核有重要价值,但阳性率不高,纤维支气管镜灌洗可进一步提高其阳性率,对咯血病因及病原学诊断起到不可忽视的作用。高分辨率CT (High Resolution Computed Tomography, HRCT)及增强CT检查在明确咯血病因方面有重要参考价值。另外,连续多次痰、胃液或肺泡灌洗液涂片找到含铁血黄素巨噬细胞可为IPH诊断提供重要线索。 (4)对于少量咯血的患儿,若病因明确,则病因治疗是关键。对于小儿大咯血的处理原则,最重要在于保持呼吸道通畅、持续给氧、及时止血和维持血容量。
[Abstract]:Objective To study the clinical characteristics of the children's blood and blood in Chongqing, and to find out the causes of the children's blood and blood, and to explore the diagnosis and treatment of the children's blood and blood with the aid of etiological, imaging and fiberoptic bronchoscopy. Methods From 2009 to 2011, 76 cases of children with primary symptoms of blood and blood were analyzed retrospectively. Point. Results (1) In this study, 76 cases of children with primary symptoms of blood and blood were included in the Affiliated Children's Hospital of Chongqing Medical University from 2009 to 2011. 1. 2: 1. Minimum age of 1/ 8, maximum 16-year-old, average age 7. 25 4. 4-year-old (2) The cause of bleeding in 76 children: The most common is infectious disease, of which 51 cases (61.1%), in which 30 of the pneumonia (39. 5%) (1 case of mycoplasma pneumonia), 16 cases of pulmonary tuberculosis (21. 1%), and bronchitis 5 (6. 6%); non-infectious diseases were the most common in the idiopathic pulmonary hemosiderosis (IPH), 3 cases (30.9%) were identified, and 8 cases of suspected IPH were found, and 3 cases (30.9%), 1 (1.3%) of bronchiectasis and 1 case of foreign body of pharynx. (1. 3%), 1 (1. 3%) of lung laceration and 1 case of severe hand-foot-mouth disease (1. 3%). The other 14 cases were not determined. There were 4 cases of suspected pulmonary tuberculosis. (3) There were 66 cases (86.8%) of the 76 cases of hypovolemia, including 29 cases (38. 1%) with blood in the sputum, 6 (7. 9%) of the medium and 4 (5. 3%) of the blood. 2 cases of children with suspected IPH, 1 case of pulmonary tuberculosis, 1 case of respiratory tract combined with digestive tract hemorrhage, 74 cases with different degree of cough, expectoration and 23 children (4) The common bacteria for sputum culture in 30 children with pneumonia were Streptococcus pneumoniae (5 cases), Moraxella catarrhalis, Haemophilus influenzae and S. aureus. (PPD) 5 cases were positive, 9 cases were diagnosed by aetiology, 7 cases of antacid were found in sputum, fasting gastric juice smear or culture, and 2 cases of antacid bacillus were found through fiberoptic bronchoscope irrigation or culture. 14 cases of hemosiderosis were completed. 23 cases of fiberoptic bronchoscopy were completed, and there were acute or chronic tracheobronchial inflammation, 10 of which suggested that there were different parts of the bronchial opening or the tube cavity stenosis, and 2 cases of old bleeding. 7 cases of anemia with different degrees were combined. (5) Of the 76 cases, 52 of the 76 children used the hemostatic, 6 of them used the posterior pituitary, and the general hemostatic drugs were the carbazoate, the vitamin K1, the phenolsulfonammine, the blood clot, and only 1 case after the administration. The children with PH still had blood in the sputum at the time of discharge, and after the treatment of the children, the blood was stopped.-No, no, no. Conclusion (1) There is no significant difference in the incidence of male and female bleeding in children. (2) Infectious diseases are the most common cause of infantile hemorrhagic fever, and the data in this group are most common in the case of pneumonia. in that second case, the pulmonary tuberculosis and the other bronchitis can also cause bleeding. the non-infectious disease is most common with the IPH, Bronchiectasis, foreign body is a rare reason for children's bleeding. (3) The blood analysis should be used as a routine examination in the children with blood. The sputum or gastric fluid smear is of great value to the diagnosis of pulmonary tuberculosis, but the positive rate is not high, and the bronchoscope lavage can further improve the positive rate. The high resolution computed tomography (HRCT) and the increase of HRCT (high resolution computed tomography) and high resolution CT (HRCT) can not be neglected. The strong CT examination is of great reference value in the determination of the cause of blood and blood. In addition, it is found that the sputum, gastric juice or alveolar lavage fluid smear is found in the continuous multiple sputum, gastric juice or alveolar lavage fluid. Emodin can provide an important clue for the diagnosis of IPH. (4) In a small number of children with blood and blood, if the cause of the disease is clear, the cause treatment is the key. The most important is the treatment principle of the child's large blood and blood.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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