儿童重症腺病毒肺炎213例临床特征分析

摘要

Objectives To summarize the clinical feature of severe adenovirus pneumonia (SAP) in children and further to improve prognosis and clinical diagnosis of SAP. Methods The clinical data of 213 children with SAP from June 2009 to June 2011 were retrospectively analyzed. Results Among 213 patients, 155 (72.8%) children were aged 6 months to 2 years, with a males to females ratio of 2.7∶1. The onset of 158 patients (74.2%) was in winter and spring. All patients had fever, 172 (80.8%) with high temperature of 39.1℃-41℃, 161 (75.6%) with a fever lasting more than 2 weeks. Two hundred and ifve (96.2%) patients had cough in the early stage, 120 (56.3%) with wheeze, 139 (65.3%) with moist rales and wheezing in the lung. Imaging ifndings in the preliminary stage of SAP showed that 63 patients (92.6%) had pulmonary interstitial changes;in critical stage, 80 patients (54.4%) had segmental consolidation and 33 (22.4%) with pleural effusion, 25 (17.0%) with pleuritis;in recovery phase, 50 patients (68.5%) showed absorption in segmental area of consolidation. All cases had complications, 175 (82.2%) with respiratory failure, including 10 (4.7%) with ARDS;among extrapulmonary complications, diseases of cardiovascular system (64.3%) and alimen-tary system (44.1%) were the most common ones, and the occurrence of myocarditis and diarrheal disease were the highest. Age, ARDS and more than two kinds of complications had adverse impact on the outcomes, and the difference was signiifcant (P<0.05). Conclusions SAP is a severe pneumonia with long duration of high fever, severe clinical manifestations with more complications. When SAP is suspected, it is recommended to complete etiological and chest radiographic examination for early diagnosis and treatment.%　　目的总结儿童重症腺病毒肺炎（SAP）的临床特点，以提高诊疗水平、改善患儿近期预后。方法回顾性分析2009年6月至2011年6月期间213例住院SAP患儿的临床资料。结果213例SAP患儿中6个月~2岁155例（72.8%），男女比率为2.7∶1，冬春季发病达158例（74.2%）。213例均有发热，体温在39.1℃~41.0℃者172例（80.8%），热程>2周者161例（75.6%）。起病初即有咳嗽205例（96.2%），喘息120例（56.3%），肺部同时出现湿啰音及哮鸣音139例（65.3%）。肺部影像学显示发病初期间质改变63例（92.6%）；极期节段性实变80例（54.4%），伴胸腔积液33例（22.4%），伴胸膜改变25例（17.0%）；恢复期实变较前吸收50例（68.5%）。213例均有并发症，合并呼吸衰竭175例（82.2%），伴急性呼吸窘迫综合征（ARDS）10例（4.7%）。肺外并发症中主要为循环系统疾病（64.3%）和消化系统疾病（44.1%），以心肌炎和腹泻最多见。年龄、ARDS、2种以上并发症对治疗效果有影响（P<0.05）。结论儿童SAP发热时间长，热度高，临床表现重，多系统并发症发生率高，临床疑诊SAP时应尽早完善病原学及胸部影像学检查，早诊断，早治疗。