重慶地區(qū)76例以咯血為主要癥狀的兒童臨床特點分析
發(fā)布時間：2019-01-26 15:39
【摘要】：目的分析重慶地區(qū)小兒咯血的臨床特點,了解引起小兒咯血原因,結(jié)合病原學(xué)、影像學(xué)、纖維支氣管鏡等輔助檢查結(jié)果,探討小兒咯血診斷思路及治療方案。 方法回顧性分析2009年～2011年重慶醫(yī)科大學(xué)附屬兒童醫(yī)院76例以咯血為主要癥狀的患兒的臨床特點。 結(jié)果 (1)本研究納入2009年～2011年重慶醫(yī)科大學(xué)附屬兒童醫(yī)院以咯血為主要癥狀的患兒76例,男女比例為1.2：1。最小年齡1月8天,最大16歲9月,平均年齡7.25±4.4歲。四季均有發(fā)病。 (2)76例患兒中咯血病因：最常見為感染性疾病,共51例(67.1%),其中肺炎30例(39.5%)(支原體肺炎1例),肺結(jié)核16例(21.1%),支氣管炎5例(6.6%)；非感染性疾病以特發(fā)性肺含鐵血黃素沉著癥(idiopathic pulmonary hemosiderosis, IPH)最常見,明確診斷有3例(3.9%),另有8例疑診IPH,其他原因可見鼻衄3例(3.9%),支氣管擴張癥1例(1.3%),咽部異物1例(1.3%),肺撕裂傷1例(1.3%),重癥手足口病1例(1.3%)。另有14例病因不確定,其中疑診肺結(jié)核4例。 (3)76例咯血患兒中,少量咯血66例(86.8%),其中表現(xiàn)為痰中帶血29例(38.1%),中量咯血6例(7.9%),大量咯血4例(5.3%)；大量咯血患兒2例疑診IPH,1例診斷肺結(jié)核,1例考慮呼吸道合并消化道出血。74例均伴有不同程度的咳嗽、咳痰癥狀,23例患兒伴隨不同程度的發(fā)熱。 (4)30例肺炎患兒痰培養(yǎng)常見細菌為肺炎鏈球菌(5例),卡他莫拉菌、流感嗜血桿菌和金黃色葡萄球菌各3例。16例結(jié)核病患兒結(jié)核菌素純蛋白衍生物(purified protein derivative, PPD)試驗陽性5例,通過病原學(xué)明確診斷9例,其中痰、空腹胃液涂片或培養(yǎng)找到抗酸桿菌7例,通過纖維支氣管鏡灌洗液涂片或培養(yǎng)找到抗酸桿菌2例。76例患兒中,可找到含鐵血黃素巨噬細胞14例。完成纖維支氣管鏡檢查者23例,均提示有急性或慢性氣管支氣管內(nèi)膜炎,其中10例提示有不同部位支氣管開口或管腔狹窄,2例可見陳舊性出血。76例咯血患兒中37例合并不同程度的貧血。 (5)76例患兒中52例使用止血藥,其中6例使用垂體后葉素,一般止血用藥為卡絡(luò)磺、維生素K1、酚磺乙胺、血凝酶,用藥后僅1例IPH患兒出院時仍有痰中帶血,余患兒用藥后咯血停止。24例患兒未使用止血藥咯血可自行停止 結(jié)論 (1)小兒咯血男女發(fā)病率無明顯差異,發(fā)病年齡多見于5歲及13歲左右。 (2)感染性疾病是小兒咯血最常見原因,本組資料顯示以肺炎最常見,其次是肺結(jié)核,另外支氣管炎也可引起咯血。非感染性疾病以IPH最常見,支氣管擴張癥、異物是小兒咯血較少見原因。 (3)血液分析應(yīng)作為咯血患兒常規(guī)檢查。痰或胃液涂片找抗酸桿菌對確診肺結(jié)核有重要價值,但陽性率不高,纖維支氣管鏡灌洗可進一步提高其陽性率,對咯血病因及病原學(xué)診斷起到不可忽視的作用。高分辨率CT (High Resolution Computed Tomography, HRCT)及增強CT檢查在明確咯血病因方面有重要參考價值。另外,連續(xù)多次痰、胃液或肺泡灌洗液涂片找到含鐵血黃素巨噬細胞可為IPH診斷提供重要線索。 (4)對于少量咯血的患兒,若病因明確,則病因治療是關(guān)鍵。對于小兒大咯血的處理原則,最重要在于保持呼吸道通暢、持續(xù)給氧、及時止血和維持血容量。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.6
本文編號：2415632
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.6
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