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目的分析儿童大叶性肺炎的临床特点、病因、治疗及转归。方法对112例大叶性肺炎患儿的临床资料进行回顾性分析。结果治愈100例(89.29%),好转自动出院4例(3.57%),治疗效果欠佳转上级医院治疗6例(5.36%),合并脓胸转胸外科手术2例(1.79%)。住院时间最短10 d,最长24 d,平均住院时间16 d。结论儿童大叶性肺炎诊断主要靠胸片、胸部CT检查,胸部CT能提高大叶性肺炎的诊断率,减少漏诊误诊;其病原种类多,以支原体为主,在临床中反复检查MP-Ig M能提高阳性率;儿童大叶性肺炎病原菌不易明确,主要是经验用药,难治性MP感染和对大环内酯类抗生素治疗反应不佳者要考虑存在混合感染的可能。支原体感染重症者,有肺内、肺外并发症者治疗早期适当的给予甲泼尼龙、丙种球蛋白能达到满意的治疗效果。
Objective To analyze the clinical characteristics, etiology, treatment and prognosis of children with lobar pneumonia. Methods The clinical data of 112 cases of lobar pneumonia were retrospectively analyzed. RESULTS: 100 cases (89.29%) were cured, 4 cases (3.57%) were discharged spontaneously, 6 cases (5.36%) were treated in superior hospital, and 2 cases (1.79%) had thoracotomy combined with empyema. The shortest hospital stay was 10 days, the longest was 24 days and the average hospital stay was 16 days. Conclusions The diagnosis of lobar pneumonia mainly depends on chest radiography, chest CT and chest CT in diagnosis of lobar pneumonia and misdiagnosis of misdiagnosis. The pathogens are mostly mycoplasma, and MP-Ig M can increase the positive rate; children with lobar pneumonia pathogenic bacteria is not easy to clear, mainly empirical medication, refractory MP infection and macrolide antibiotics poor response to consider the possibility of mixed infection. Mycoplasma infection in patients with severe intra-pulmonary and extra-pulmonary complications in the early treatment of appropriate given methylprednisolone, gamma globulin can achieve satisfactory therapeutic effect.