本文關鍵詞：兒童重癥社區(qū)獲得性肺炎的病原學分析　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 兒童 重癥 社區(qū)獲得性肺炎 病原學

【摘要】：目的:兒童重癥肺炎及其并發(fā)癥,尤其是全身炎癥反應和多器官功能障礙,是威脅患兒健康和生命的主要原因。許多研究證實不同地區(qū)的病原譜有較大的差異,但在疾病的早期,難以獲得明確的病原結果,需進行恰當?shù)慕?jīng)驗性用藥。本文通過對近3年在我院住院的重癥社區(qū)獲得性肺炎患兒的血清呼吸道病毒抗體、肺炎支原體及衣原體抗體、痰培養(yǎng)、血培養(yǎng)、肺泡灌洗液培養(yǎng)等病原結果進行統(tǒng)計,分析大連地區(qū)重癥社區(qū)獲得性肺炎患兒的病原學特點,以便指導臨床工作。方法:選取2014年1月至2016年12月在大連市兒童醫(yī)院住院的550例重癥社區(qū)獲得性肺炎患兒,回顧性分析其病原資料。入選患者均符合重癥社區(qū)獲得性肺炎診斷標準。入院24小時內完成患兒氣道深部痰培養(yǎng)、不同部位血培養(yǎng)、血清常見呼吸道病毒抗體IgM、血清肺炎支原體及衣原體抗體IgM標本采集,并盡快送檢,統(tǒng)計上述病原結果及部分患兒的肺泡灌洗液病原檢測結果,同時記錄一般資料及合并并發(fā)癥情況。另外,分析不同年齡組(29天～12月、～36月、～72月、～168月)、不同季節(jié)(春季、夏季、秋季、冬季)病原體的差異。采用SPSS 20.0軟件對所有數(shù)據(jù)進行統(tǒng)計學分析。結果:1.病原體總陽性率為58.2%,其中細菌感染為35.3%,混合感染20.3%,非典型病原體感染20.0%,病毒感染為15.6%,真菌感染8.8%。2.550例均行痰培養(yǎng),檢出病原177株,細菌142株(80.2%),革蘭氏陰性菌、革蘭氏陽性菌分別為97株(54.8%)、45株(25.4%),其中肺炎克雷伯桿菌32株、大腸埃希菌25株、金黃色葡萄球菌19株;真菌35株,其中白假絲酵母菌31株。3.345例行血培養(yǎng),檢出病原112株,細菌為102株(91.1%),革蘭氏陰性菌、革蘭氏陽性菌分別為60株(53.6%)、42株(37.5%),其中肺炎克雷伯桿菌21株、肺炎鏈球菌16株、鮑曼不動桿菌15株;真菌10株,其中白假絲酵母菌8株。4.100例留取肺泡灌洗液(BALF)進行病原學檢測,共檢出病原38株,細菌最常見,為25株(65.8%),革蘭氏陰性菌、革蘭氏陽性菌15株(39.5%)、10株(26.3%),其中鮑曼不動桿菌9株、肺炎鏈球菌8株;肺炎支原體13株(34.2%)。5.550例均行血清肺炎支原體及衣原體、血清常見呼吸道病毒抗體IgM檢測,共檢出非典型病原112株、病毒88株,前者中肺炎支原體96株,后者中呼吸道合胞病毒31株、巨細胞病毒17株。6.29天～12月組中細菌占68.2%、病毒占22.3%,～36月組中細菌占29.8%,非典型病原占40.5%,～72月組中非典型病原占67.3%。7.夏季中細菌占61.3%,秋季非典型病原占42.9%,冬季中細菌占49.7%。結論:1.大連地區(qū)兒童重癥CAP病原依次為細菌、肺炎支原體、病毒、真菌,細菌以肺炎克雷伯桿菌、肺炎鏈球菌為主,病毒則以呼吸道合胞病毒為主,根據(jù)病原譜可更恰當選擇藥物。2.病原譜因發(fā)病年齡和季節(jié)而有所不同,因此,應盡早獲得病原結果,以更好指導臨床。
[Abstract]:Objective: severe pneumonia in children and its complications, especially systemic inflammatory reaction and multiple organ dysfunction, are the main causes that threaten children's health and life. However, in the early stage of the disease, it is difficult to obtain a definite result of the pathogen, so it is necessary to carry out appropriate empirical drug use. This article reports the respiratory virus antibodies in the serum of the children with severe community-acquired pneumonia who were hospitalized in our hospital in recent three years. The pathogenic results of mycoplasma pneumoniae and chlamydia pneumoniae antibody, sputum culture, blood culture and alveolar lavage fluid culture were analyzed and the etiological characteristics of children with severe community-acquired pneumonia in Dalian area were analyzed. Methods: from January 2014 to December 2016, 550 children with severe community acquired pneumonia in Dalian Children's Hospital were selected. Retrospective analysis of the pathogenic data. Selected patients were in line with the criteria for the diagnosis of severe community-acquired pneumonia. 24 hours after admission, the children completed the deep airway sputum culture, different parts of blood culture. The common respiratory virus antibody IgM, the serum mycoplasma pneumoniae and chlamydia antibody IgM samples were collected and submitted to the laboratory as soon as possible. The results of the above pathogens and some of the children's alveolar lavage fluid pathogens were counted. At the same time, the general data and complications were recorded. In addition, 29 days to December ~ 32 ~ 72 ~ 16 August were analyzed in different age groups, different seasons (spring, summer and autumn). SPSS 20.0 software was used to analyze all the data. Results: 1. The total positive rate of pathogens was 58.2, in which bacterial infection was 35.3%. 20. 3% mixed infection, 20. 0% atypical pathogen infection, 15. 6% virus infection, 8. 8% fungus infection and 2. 550 cases of fungal infection were all treated with sputum culture and 177 strains of pathogen were detected. There were 142 strains of bacteria including 80.2%, gram-negative and gram-positive respectively 97 strains (54.8%) and 45 strains (25.4%), among which 32 strains were Klebsiella pneumoniae (Klebsiella pneumoniae). 25 strains of Escherichia coli and 19 strains of Staphylococcus aureus; Among 35 strains of fungi, 31 strains of Candida albicans. 3.345 were routinely cultured in blood. 112 strains of pathogenic bacteria were detected, and 102 strains of bacteria were found to be 91.1%, Gram-negative bacteria. There were 60 strains of Gram-positive bacteria and 42 strains of Klebsiella pneumoniae, 16 strains of Streptococcus pneumoniae and 15 strains of Acinetobacter baumannii. 10 strains of fungi, 8 strains of Candida albicans. 4.100 cases of BALF were collected from alveolar lavage fluid to detect the pathogens, 38 strains of pathogens were detected, the most common bacteria were found. There were 25 strains of Acinetobacter baumannii, 9 strains of Gram-negative bacteria, 15 strains of Gram-positive bacteria and 10 strains of Acinetobacter baumannii, 8 strains of Streptococcus pneumoniae. All 13 strains of Mycoplasma pneumoniae were detected by serum mycoplasma pneumoniae and chlamydia pneumoniae, and 112 strains of atypical pathogens were detected by IgM. There were 88 strains of virus, 96 strains of Mycoplasma pneumoniae, 31 strains of respiratory syncytial virus, 17 strains of cytomegalovirus, 68.2% of bacteria and 22.3% of virus. In the group of ~ 36 months, bacteria accounted for 29.8%, atypical pathogens accounted for 40.5% and non-typical pathogens accounted for 67.3% in the group of 72.The bacteria accounted for 61.3% in summer. In autumn, atypical pathogens accounted for 42.9 and in winter, bacteria accounted for 49.7. Conclusion: 1. Severe CAP pathogens of children in Dalian are bacteria, mycoplasma pneumoniae, viruses and fungi in turn. Klebsiella pneumoniae, Streptococcus pneumoniae, respiratory syncytial virus as the main bacteria, according to the pathogenic spectrum can be more appropriate to choose drugs .2.The pathogenic spectrum varies according to onset age and season, therefore. The pathogenic results should be obtained as soon as possible in order to better guide clinical practice.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R725.6
，

本文編號：1407920