Heaton P, Arthur K
Paediatric Department, Taranaki Base Hospital, New Plymouth.
N Z Med J. 1998 Aug 28;111(1072):315-7.
We conducted this study to determine whether chest radiography was clinically useful in the follow-up of uncomplicated pneumonia affecting children aged between 6 weeks and 15 years.
We examined the case records of all 78 paediatric admissions for pneumonia to our hospital over one year. Thirteen children were excluded on account of age or other complicating factors.
Of the 65 study cases, the mean age was 3.5 years (range 0.4-13 years). On admission 51 (79%) had cough, 53 (82%) fever, 53 (82%) tachypnoea and 50 (77%) had abnormal chest signs. Elevation of C reactive protein was recorded in 43 (66%) cases and leukocytosis in 42 (65%). All children received initial chest radiographs which showed unilobular/lobar changes in 34 (53%), bilobar changes in 19 (29%) and diffuse abnormalities in 7 (11%). Forty-one patients were followed up both clinically and radiologically, usually (31 cases) between four and six weeks after discharge. Thirty-seven children had no abnormal symptoms or signs and had normal chest radiographs. The remaining four had symptoms and signs, their radiographs showed either slight resolution or no change from the admission films.
In cases of uncomplicated pneumonia, follow-up chest radiography should be deferred until at least four weeks after discharge and is not indicated if symptoms and signs are absent.
我们开展这项研究以确定胸部X线检查对6周龄至15岁儿童单纯性肺炎随访是否具有临床实用性。
我们检查了我院一年中所有78例因肺炎入院的儿科病例记录。13名儿童因年龄或其他复杂因素被排除。
65例研究病例的平均年龄为3.5岁（范围0.4 - 13岁）。入院时，51例（79%）有咳嗽，53例（82%）发热，53例（82%）呼吸急促，50例（77%）有胸部异常体征。43例（66%）C反应蛋白升高，42例（65%）白细胞增多。所有儿童均接受了初始胸部X线检查，其中34例（53%）显示单叶/大叶改变，19例（29%）显示双叶改变，7例（11%）显示弥漫性异常。41例患者接受了临床和放射学随访，通常（31例）在出院后4至6周进行。37名儿童无异常症状和体征，胸部X线检查正常。其余4例有症状和体征，其X线片显示与入院时相比略有吸收或无变化。
对于单纯性肺炎病例，应推迟至出院后至少四周进行随访胸部X线检查，无症状和体征时无需进行此项检查。
