摘要
目的 了解儿科重症监护病房（PICU）患儿胸腔积液的常见病因及相关影响因素。方法 对我院2000年1月～2006年3月收入PICU的55例胸部放射学和（或）胸部B超确诊为胸腔积液患儿的临床资料进行回顾性分析。结果 55例中以感染为原因者占76．36％，肿瘤性疾病18．18％，其他5．46％。本组死亡3例，病死率5．46％；细菌感染组17例培养阳性，9例为G^＋菌（5例肺炎链球菌），8例G^-菌（4例铜绿假单孢菌）；恶性肿瘤组血LDH增高与细菌感染组相比，有统计学差异；细菌感染组与恶性肿瘤组胸水细胞计数分类比较，结果 显示多形核细胞分类与单核细胞分类差异均显著；脓胸与非脓胸细菌感染组胸水中糖含量比较，差异有显著性；脓胸组治疗后胸水平均消失时间与非脓胸组比较，差异有显著性。结论 本组胸腔积液患儿，以细菌感染为主，G^＋菌及G^-菌均是重要致病菌，并提示PICU要特别重视铜绿假单胞菌的感染；血LDH增高的程度及胸水细胞分类计数有助于早期鉴别恶性或感染性胸腔积液；细菌感染者胸水糖含量的高低，可以预示疾病严重程度及内科治疗的效果。
Objective To identify the common causes and related factors of pleural effusion （PE） in PICU. Methods A retrospective analysis was performed on fifty-five children hospitalized in PICU from January of 2000 to March of 2006 with a radiographic or ultrasound diagnosis of PE. Results Of 55 patients with PE, infection, tumor and other miscellaneous causes accounted for 76.36 %, 18.18 % and 5.46 % respectively. Three patients died with mortality rate of 5.46 %. Seventeen bacterial infection cases showed 9 Gram-positive culture results（5 streptococcus pneumoniae）and 8 Gram-negative （4 pseudomonas aeruginosa）. Patients with malignant pleural effusion presented significantly higher serum lactate dehydrogenase （LDH） than those with bacterial infection. Polymorphonuclear neutrophil and monocyte percentage in malignant pleural fluid （PF） was significantly different from those of bacterial infectious PF. Among the infectious cases, PF glucose level between empyema and non-empyema was significantly different. Furthermore, the mean disappearance time of PF differed significantly between empyema and non-empyema. Conclusion In our study, the major cause of PE was infection. Both Gram positive and Gram negative bacteria were important pathogens. Moreover, we suggested that Pseudomonas infection should not be neglected in PICU. Serum LDH and PF polymorphonuclear neutrophil count were useful for early differential diagnosis between infectious and malignant PF. PF glucose level might predict the severity of the infectious disease and the patients＇ response to treatment.
出处
《中国小儿急救医学》
CAS
2006年第6期528-530,共3页
Chinese Pediatric Emergency Medicine
