肺炎并肺不张690例病原学分析

doi:10.12372/jcp.2022.21e0706

Abstract

Abstract: Objective To study the etiological characteristics of pneumonia complicated with atelectasis in the city of Chongqing.Methods The clinical data of 690 children with pneumonia complicated with atelectasis were collected, and a retrospective analysis was performed on the characteristics of pathogen, involved lobes and the clinical effect of bronchoalveolar lavage.Results A total of 690 children (353 boys and 337 girls) were included and the median age was 4.1 (2.5~6.8) years. Among them, 601 children (87.1%) had definite pathogens. Mycoplasma pneumoniae was the commonest pathogen (330 cases, 47.8%), followed by bacteria (271 cases, 39.3%) and virus (209 cases, 30.3%). There were significant differences in pathogen distribution among different age groups and different season groups (P<0.001). The proportion of bacteria, virus and bacteria combined with virus infection was higher in infant and young children group. The proportion of mycoplasma infection was higher in preschool and school-age children. The proportion of bacterial infection was higher in spring and autumn, that of virus infection was higher in winter, and that of mycoplasma infection was higher in summer and autumn. There were statistically significant differences in the predisposition sites of pneumonia with atelectasis among different age groups (P<0.001). The proportion of atelectasis in the upper lobe of the right lung was higher in the infant group, and that in the middle lobe of the right lung was higher in the young children, pre-school age and school age groups. The frequency of bronchoalveolar lavage was significantly correlated with the type of pathogen and the number of affected lobes (P<0.01). The proportion of one time of bronchoalveolar lavage in children with single pathogen infection and single lobe atelectasis was high.Conclusions Mycoplasma pneumoniae is the commonest pathogen of pneumonia complicated with atelectasis, and there are differences in pathogen composition among different ages and seasons. The main involved lobe is the right middle lobe. The prognosis is closely related to the pathogen of infection and the number of affected lobes, and refractory atelectasis is easily caused by mixed infection and multilobed atelectasis.

Key words: atelectasis, pathogen, bronchoalveolar lavage, child

LI Yuehan, LIU Zheng, FU Zhou, YANG Zhimei. Etiological analysis of 690 cases of pneumonia complicated with atelectasis[J].Journal of Clinical Pediatrics, 2022, 40(4): 268-273.

Figures/Tables 5

References 29

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病原体	婴儿组(n=115)	幼儿组(n=134)	学龄前期组(n=214)	学龄期组(n=227)
细菌	32（27.8）	36（26.9）	37（17.3）	24（10.6）
病毒	31（27.0）	16（11.9）	14（6.5）	9（4.0）
支原体	6（5.2）	19（14.2）	75（35.0）	110（48.5）
细菌+病毒	24（20.9）	26（19.4）	16（7.5）	6（2.6）
细菌+支原体	2（1.7）	8（6.0）	26（12.1）	17（7.5）
病毒+支原体	1（0.9）	7（5.2）	15（7.0）	27（11.9）
细菌+病毒+支原体	7（6.1）	3（2.2）	5（2.3）	2（0.9）
未检出	12（10.4）	19（14.2）	26（12.1）	32（14.1）

病原体	春季组(n=129)	夏季组(n=214)	秋季组(n=152)	冬季组(n=195)
细菌	32（24.8）	30（14.0）	34（22.4）	33（16.9）
病毒	8（6.2）	22（10.3）	7（4.6）	33（16.9）
支原体	25（19.4）	84（39.3）	55（36.2）	46（23.6）
细菌+病毒	15（11.6）	12（5.6）	17（11.2）	28（14.4）
细菌+支原体	12（9.3）	15（7.0）	12（7.9）	14（7.2）
病毒+支原体	12（9.3）	13（6.1）	8（5.3）	17（8.7）
细菌+病毒+支原体	1（0.8）	7（3.3）	4（2.6）	5（2.6）
未检出	24（18.6）	31（14.5）	15（9.9）	19（9.7）

好发部位	例数(%)	婴儿组(n=115)	幼儿组(n=134)	学龄前期组(n=214)	学龄期组(n=227)
右上叶	152(22.0)	58（50.4）	27（20.1）	37（17.3）	30（13.2）
右中叶	200(29.0)	16（13.9）	38（28.4）	75（35.0）	71（31.3）
右下叶	63(9.1)	4（3.5）	10（7.5）	14（6.5）	35（15.4）
左上叶	86(12.5)	3（2.6）	19（14.2）	32（15.0）	32（14.0）
左下叶	78(11.3)	8（7.0）	19（14.2）	20（9.3）	31（13.7）
2个肺叶	100(14.5)	20（17.4）	19（14.2）	34（15.9）	27（11.9）
≥3个肺叶	11(1.6)	6（5.2）	2（1.5）	2（0.9）	1（1.6）

组别	例数	1次	2次	3次	>3次
单病原组	416	322（77.4）	62（14.9）	14（3.4）	18（4.3）
多病原组	185	126（68.1）	32（17.3）	10（5.4）	17（9.2）

组别	例数	1次	2次	3次	>3次
单叶肺不张组	579	461（79.6）	77（13.3）	18（3.1）	23（4.0）
多叶肺不张组	111	65（58.6）	25（22.5）	8（7.2）	13（11.7）

Etiological analysis of 690 cases of pneumonia complicated with atelectasis

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