小儿脓胸的病原学特征与治疗临床研究(1)
[摘要] 目的 探討小儿脓胸的病原学特征与临床治疗策略。方法 方便选择2015年1月—2018年1月期间该院收治的96例小儿脓胸患儿，根据患儿病情采取适当的治疗手段，所有患儿均在治疗前采集血液、痰液、胸水及肺泡灌洗液样本进行细菌培养、鉴定检查，分类统计患儿病原菌感染情况，并监测患儿预后。结果 该组96例患儿中，细菌培养及鉴定结果显示阳性者共54例(56.25%)，其中肺炎链球菌16例(16.67%)和表皮葡萄球菌14例(14.58%)检出率最高，显著高于人葡萄球菌8例(8.33%)，腐生葡萄球菌4例(4.18%)，溶血性葡萄球菌2例(2.08%)，尿肠球菌2例(2.08%)，鲍曼不动杆菌2例(2.08%)，金黄色葡萄球菌2例(2.08%)，凝固酶阴性葡萄球菌2例(2.08%)，白色念珠菌2例(2.08%)，差异有统计学意义(P<0.05)。16例行胸腔穿刺术及胸腔闭式引流术，34例行胸腔闭式引流术联合纤维支气管镜肺泡灌洗术，32例行支气管肺泡灌洗术及胸腔镜下脓液清除及纤维板剥脱术，均治疗后痊愈，无转为开胸手术者。14例患儿行开胸手术治疗：12例行开胸纤维板剥脱术，2例行肺叶切除术，患儿均痊愈。结论 肺炎链球菌和表皮葡萄球菌是小儿脓胸的主要病原菌，胸腔穿刺术及腔镜治疗临床疗效可靠，可作为首选治疗手段。
[关键词] 小儿脓胸；病原学特征；临床治疗；腔镜
[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-0742(2018)10(b)-0004-03
[Abstract] Objective To investigate the etiology and clinical treatment strategies of children with empyema. Methods A total of 96 children with empyema who were admitted to the hospital from January 2015 to January 2018 were convenient enrolled. According to the patient's condition， appropriate treatment was adopted. All patients received blood， sputum， pleural effusion and alveoli before treatment. The lavage fluid samples were cultured and identified， and the pathogen infections of the children were classified and monitored， and the prognosis of the children was monitored. Results Among the 96 children in this group， 54 cases (56.25%) showed positive results in bacterial culture and identification. Among them， 16 cases (16.67%) of Streptococcus pneumoniae and 14 cases (14.58%) of Staphylococcus epidermidis had the highest detection rate， significantly higher than 8 cases of human staphylococcus(8.33%)， 4 cases of Staphylococcus aureus(4.18%)， 2 cases of hemolytic staphylococcus (2.08%)， 2 cases of Enterococcus faecium(2.08%)， Acinetobacter baumannii 2 cases(2.08%)， 2 cases (2.08%) of Staphylococcus aureus， 2 cases (2.08%) of coagulase-negative staphylococci， and 2 cases of candida albicans (2.08%)， the difference was statistically significant(P<0.05). 16 cases underwent thoracentesis and closed thoracic drainage， 34 cases underwent thoracic closed drainage combined with fiberoptic bronchoscopy， 32 cases underwent bronchoalveolar lavage and thoracoscopic pus removal and fibrectomy. All were cured after treatment， and no conversion to open surgery. 14 patients underwent open thoracotomy： 12 patients underwent open chest fiber stripping and 2 underwent lobectomy. All children recovered. Conclusion Streptococcus pneumoniae and Staphylococcus epidermidis are the main pathogens of pediatric empyema. Thoracic puncture and laparoscopic treatment are reliable and can be used as the first choice., 百拇医药(贾宇飞 唐令)
[关键词] 小儿脓胸；病原学特征；临床治疗；腔镜
[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-0742(2018)10(b)-0004-03
[Abstract] Objective To investigate the etiology and clinical treatment strategies of children with empyema. Methods A total of 96 children with empyema who were admitted to the hospital from January 2015 to January 2018 were convenient enrolled. According to the patient's condition， appropriate treatment was adopted. All patients received blood， sputum， pleural effusion and alveoli before treatment. The lavage fluid samples were cultured and identified， and the pathogen infections of the children were classified and monitored， and the prognosis of the children was monitored. Results Among the 96 children in this group， 54 cases (56.25%) showed positive results in bacterial culture and identification. Among them， 16 cases (16.67%) of Streptococcus pneumoniae and 14 cases (14.58%) of Staphylococcus epidermidis had the highest detection rate， significantly higher than 8 cases of human staphylococcus(8.33%)， 4 cases of Staphylococcus aureus(4.18%)， 2 cases of hemolytic staphylococcus (2.08%)， 2 cases of Enterococcus faecium(2.08%)， Acinetobacter baumannii 2 cases(2.08%)， 2 cases (2.08%) of Staphylococcus aureus， 2 cases (2.08%) of coagulase-negative staphylococci， and 2 cases of candida albicans (2.08%)， the difference was statistically significant(P<0.05). 16 cases underwent thoracentesis and closed thoracic drainage， 34 cases underwent thoracic closed drainage combined with fiberoptic bronchoscopy， 32 cases underwent bronchoalveolar lavage and thoracoscopic pus removal and fibrectomy. All were cured after treatment， and no conversion to open surgery. 14 patients underwent open thoracotomy： 12 patients underwent open chest fiber stripping and 2 underwent lobectomy. All children recovered. Conclusion Streptococcus pneumoniae and Staphylococcus epidermidis are the main pathogens of pediatric empyema. Thoracic puncture and laparoscopic treatment are reliable and can be used as the first choice., 百拇医药(贾宇飞 唐令)