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目的探讨小儿支气管肺炎伴心肌损伤的临床特点及治疗。方法选取成都市西区医院2015年12月—2016年12月收治的支气管肺炎伴心肌损伤患儿50例,均给予胸部X线和CT检查、心电图及实验室相关检查,并给予综合性治疗,比较患儿治疗前后心肌酶变化情况[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、丙氨酸氨基转移酶(ALT)、乳酸脱氢酶(LDH)]及临床疗效。结果 50例患儿中,左侧肺病变20例(40.0%),右侧肺病变19例(38.0%),双侧肺部病变11例(27.5%),肺纹理模糊不清,或纹理增粗,同时肺部还存在大小不一的点状阴影区域;痰培养显示:肺炎链球菌感染17例(34.0%),支原体感染15例(30.0%),铜绿假单细胞菌感染9例(18.0%),流感杆菌感染9例(18.0%)。心电图检查显示:窦性心动过速11例(27.5%),窦性心动过缓8例(16.0%)、肢体低电压6例(12.0%)、窦性心律不齐15例(30.0%)、房室传导阻滞5例(10.0%)、期前收缩5例(10.0%)。患儿治疗后CK、CK-MB、ALT、LDH水平低于治疗前(P<0.05),治疗总有效率为96.00%。结论小儿支气管肺炎伴心肌损伤易累及双肺,并感染肺炎链球菌、支原体铜绿假单细胞菌、流感杆菌等致病菌,常伴窦性心动过速、窦性心动过缓、肢体低电压、窦性心律不齐、房室传导阻滞与期前收缩等症状,经综合对症治疗疗效确切,可明显改善患儿的临床症状。
Objective To investigate the clinical characteristics and treatment of bronchial pneumonia with myocardial injury in children. Methods Fifty children with bronchopneumonia with myocardial injury admitted from December 2015 to December 2016 in Chengdu Western Hospital were enrolled in this study. All patients underwent X-ray and CT examinations, electrocardiogram and laboratory tests, and were given comprehensive treatment. Changes of myocardial enzymes before and after treatment in children [creatine kinase (CK), creatine kinase (CK-MB), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) Results Among the 50 cases, 20 cases (40.0%) of the left lung lesions, 19 cases (38.0%) of the right lung lesions and 11 cases (27.5%) of the bilateral lung lesions had unclear lungs or increased texture In the sputum culture, 17 cases (34.0%) were infected with S. pneumoniae, 15 cases (30.0%) were infected with mycoplasma, 9 cases were infected with Pseudomonas aeruginosa (18.0%) %), 9 cases of influenza bacilli infection (18.0%). Electrocardiogram showed sinus tachycardia in 11 cases (27.5%), sinus bradycardia in 8 cases (16.0%), limb low voltage in 6 cases (12.0%), sinus arrhythmia in 15 cases (30.0%), Atrioventricular block in 5 cases (10.0%), before the contraction in 5 cases (10.0%). The levels of CK, CK-MB, ALT and LDH in children after treatment were lower than those before treatment (P <0.05), and the total effective rate was 96.00%. Conclusions Children with bronchopneumonia and myocardial injury are likely to involve the lungs and are infected with pathogens such as Streptococcus pneumoniae, Mycoplasma Pseudomonas aeruginosa, and influenza bacilli, often accompanied by sinus tachycardia, sinus bradycardia, limb low voltage, Sinus arrhythmia, atrioventricular block and premenstrual contraction and other symptoms, the exact effect of the comprehensive symptomatic treatment can significantly improve the clinical symptoms of children.