Li Jiujun, Zhao Ying, Liu Zhe, Zhang Tao, Liu Chunfeng, Liu Xin
Shengjing hospital of China Medical University, Shenyang, China.
J Infect Dev Ctries. 2015 Oct 29;9(10):1139-46. doi: 10.3855/jidc.6534.
Despite tremendous progress made toward elimination, measles continues to pose a great threat to the health of children in developing countries. The objective of this study was to summarize and analyze the clinical characteristics and treatment experience of serious complications of measles pneumonia in children.
The study group comprised 58 infants with severe measles pneumonia who were admitted to the Second Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, from December 2013 through May 2014. The clinical characteristics of complications such as hypoxemia, acute respiratory distress syndrome (ARDS), sepsis, pneumothorax, multiple organ dysfunction syndrome (MODS), and intracranial infection were retrospectively analyzed; in addition, the death cases were summarized and analyzed.
The 58 infants experienced the following: hypoxemia, 100%; ARDS, 21%; sepsis, 34%; pneumothorax, 14%; MODS, 16%; and intracranial infection, 9%. A total of 7 infants developed a secondary bacterial infection, and 12 infants received mechanical ventilation (5 with high-frequency mechanical ventilation and 3 with mechanical ventilation and NO inhalation); the average duration of mechanical ventilation was 10.08 days, and 3 infants expired.
Children with measles pneumonia may experience multiple serious complications, among which ARDS and pneumothorax are particularly serious. If a patient's condition changes abruptly, it is crucial to promptly respond to the change and to administer mechanical ventilation and appropriate antibiotics. For patients with a severe pneumothorax, and especially those with severe mediastinal emphysema, timely, continuous, retrosternal, closed thoracic drainage can effectively relieve compression.
尽管在消除麻疹方面取得了巨大进展,但麻疹仍然对发展中国家儿童的健康构成重大威胁。本研究的目的是总结和分析儿童麻疹肺炎严重并发症的临床特征及治疗经验。
研究组包括2013年12月至2014年5月在中国医科大学附属盛京医院第二小儿重症监护病房收治的58例重症麻疹肺炎患儿。对低氧血症、急性呼吸窘迫综合征(ARDS)、败血症、气胸、多器官功能障碍综合征(MODS)和颅内感染等并发症的临床特征进行回顾性分析;此外,对死亡病例进行总结分析。
58例患儿出现以下情况:低氧血症,100%;ARDS,21%;败血症,34%;气胸,14%;MODS,16%;颅内感染,9%。共有7例患儿发生继发性细菌感染,12例患儿接受机械通气(5例采用高频机械通气,3例采用机械通气并吸入一氧化氮);机械通气平均持续时间为10.08天,3例患儿死亡。
麻疹肺炎患儿可能会出现多种严重并发症,其中ARDS和气胸尤为严重。如果患者病情突然变化,及时应对变化并给予机械通气和适当的抗生素至关重要。对于严重气胸患者,尤其是伴有严重纵隔气肿的患者,及时、持续的胸骨后闭式胸腔引流可有效缓解压迫。