本文選題：肺不張 + 兒童�。� 參考：《重慶醫(yī)科大學(xué)學(xué)報(bào)》2017年12期

【摘要】：目的:探討肺不張兒童支氣管鏡下病變、支氣管肺泡灌洗液病原學(xué)及兩者之間的關(guān)系。方法:回顧性分析重慶醫(yī)科大學(xué)附屬兒童醫(yī)院呼吸中心2011年12月至2016年6月確診肺不張并行支氣管鏡檢查患兒共412例,通過Chi-square with Yates'correction檢驗(yàn)和Fisher精確檢驗(yàn)比較不同部位肺不張鏡下異常和檢出病原的差異。結(jié)果:(1)肺不張前兩位是右中葉不張(41.0%,169/412)和右上葉(40.7%,168/412),前者在3歲組檢出率明顯增高(115/223 vs.54/189,P=0.000),后者在≤3歲組檢出率明顯增高(110/189 vs.58/223,P=0.000)。支氣管鏡檢異常155例,前三位為支氣管狹窄85例(54.8%)、化膿性內(nèi)膜炎45例(29.0%)、黏液栓21例(13.5%)。(2)支氣管肺泡灌洗液病原檢出240例(58.2%),其中細(xì)菌141例(34.2%)和肺炎支原體126例(30.5%)。鼻咽抽吸物病毒檢出74例(18.0%)。(3)右中葉病變化膿性內(nèi)膜炎32例(18.9%),化膿性內(nèi)膜炎組肺炎鏈球菌檢出較非化膿組明顯增高(13/32 vs.24/137,P=0.009)。右上葉狹窄52例(31.0%),狹窄組腸桿菌科細(xì)菌檢出率(15/52 vs.15/116,P=0.023)和早產(chǎn)兒率(16/52 vs.18/116,P=0.039)較非狹窄組明顯增高。黏液栓組肺炎支原體檢出率明顯高于非黏液栓組(11/21vs.115/391,P=0.047)。結(jié)論:兒童肺不張部位與年齡有關(guān)。肺不張受累葉或段支氣管可存在狹窄、化膿性內(nèi)膜炎和黏液栓等病變,狹窄和化膿性內(nèi)膜炎與細(xì)菌有關(guān),黏液栓與肺炎支原體有關(guān)。
[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.
【作者單位】： 重慶醫(yī)科大學(xué)附屬兒童醫(yī)院禮嘉呼吸科兒童發(fā)育疾病研究教育部重點(diǎn)實(shí)驗(yàn)室兒童發(fā)育重大疾病國家國際科技合作基地兒科學(xué)重慶市重點(diǎn)實(shí)驗(yàn)室;
【基金】：國家臨床重點(diǎn)專科建設(shè)資助項(xiàng)目(編號:2011-873)
【分類號】：R725.6

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