摘要
目的评价儿童社区获得性肺炎的病原微生物耐药性与抗菌药应用情况及处方的合理性。方法选择2019年4月至2020年10月于惠州市第一妇幼保健院进行诊断治疗的儿童社区获得性肺炎(CAP)患者共计150例临床资料进行回顾性分析。比较两组诊断结果,对相关数据进行分析。结果胸部X线显示,有12例肺不张者、42例呈大片状阴影者、96例支气管肺炎者,分别占比8.00%、28.00%、64.00%。在首发症状方面,有4例意识障碍、13例腹痛、34例胸痛、36例发热、40例胸闷气短、75例咯痰、87例咳嗽,分别占比2.67%、8.67%、22.67%、24.00%、26.67%、50.00%、58.00%。血常规显示,66例患儿白细胞总数>10×10^(9)/L(44.04%),100例患儿中性粒细胞占比>75%(66.67%)。痰细菌培养方面,58.00%患者检出病原体(87/150),其中革兰阳性菌、革兰阴性菌分别占比41.38%(36/87)、55.17%(48/87),混合感染3例。病原菌分布中,肠埃希菌、肺炎克雷伯杆菌等革兰阴性菌处于主要地位;金黄色葡萄球菌、肺炎链球菌等革兰阳性菌居于次要地位。药敏试验显示,肺炎病原菌对抗生素均存在不同程度的耐药,但仍有敏感的抗生素可供选择。及时给予经验性抗感染,以及根据药敏结果调整治疗后,150例患者中,治愈、好转、治疗无效的例数分别为50例、90例、10例,分别占比33.33%、60.00%、6.67%,总疗效为93.33%。结论支气管肺炎是儿童CAP的常见胸部X线表现,首发症状方面以咳嗽、咯痰为主,伴白细胞和中性粒细胞数升高,该疾病的主要病因为多重病原体感染,但采取针对性干预后,可有效改善患者病症。
Objective To evaluate drug resistance of pathogenic microorganism and application of antibacterial drugs in children with community-acquired pneumonia and prescriptions'rationality.Methods The clinical data of a total of 150 pediatric CAP patients who underwent diagnostic treatment in Huizhou No.1 Maternal and Child Care Service Center from April 2019 to October 2020 were retros pectively analyzed.The diagnostic results of the two g roups were compared and the relevant data were analyzed.Results In terms of chest X-ray findings,there were 12 cases of atelectasis,42 cases of large shadow and 96 cases of bronchopneumonia,accounting for 8.00%,28.00%and 64.00%respectively.In terms of initial symptoms,there were 4 cases of consciousness disorder,13 cases of abdominal pain,34 cases of chest pain,36 cases of fever,40 cases of short chest tightness,75 cases of expectoration and 87 cases of cough.Each symptom accounted for 2.67%,8.67%,22.67%,24.00%,26.67%,50.00%and 58.00%respectively.Blood routine examination showed that the total number of leukocytes in 66 cases of children was more than 10×10^(9)/L(44.04%),100 cases of children with neutrophils accounting for more than 75%(66.67%).In terms of sputum bacterial culture,pathogens were detected in 58.00%of patients(87/150),of which Gram-positive bacteria and Gram-negative bacteria accounted for 41.38%(36/87)and 55.17%(48/87),respectively.There were 3 cases of mixed infection.Gram negative bacteria such as Escherichia coli and Klebsiella pneum oniae were the main pathogens;Gram positive bacteria such as Staphylococcus aureus and Streptococcus pneumoniae were in the secondary low position.Drug sensitivity test showed that the pathogens of pneumonia had different degrees of resistance to antibiotics,but there were still sensitive antibiotics to choose from.After timely empirical anti infection and adjustment of treatment according to drug sensitivity results,among 150 patients,50 cases were cured,90 cases were improved and 10 cases were ineffective,accounting for 33.33%,60.00%and 6.67%respectively.The total curative effect was 93.33%.Conclusion The chest X-ray manifestations of community-acquired pneumonia in children are mainly bronchopneumonia.The first symptoms are mainly cough and expectoration,accompanied by the increase of the number of leukocytes and neutrophils.The main cause of the disease is multiple pathogen infection,but the situation of the patients can be effectively improved after targeted intervention.
作者
梁群娣
刘燕好
黄远标
张育超
张翠平
李文斌
LIANG Qundi;LIU Yanhao;HUANG Yuanbiao;ZHANG Yuchao;ZHANG Cuiping;LI Wenbin(Pharmacy Department,Huizhou No.1 Maternal and Child Care Service Center,Guangdong,Huizhou 516000,China)
出处
《中国医药科学》
2021年第20期150-153,共4页
China Medicine And Pharmacy
基金
广东省惠州市医疗卫生类科技计划项目(2019Y120)。
关键词
儿童
社区获得性肺炎
病原微生物
耐药性
抗菌药
处方
合理性
Children
Community-acquired pneumonia
Pathogenic microorganism
Drug resistance
Antibiotics
Prescriptions
Rationality
作者简介
通讯作者:刘燕好。
