|
Objective:To investigate the cause of pleural effusion in children with clinical features and treatment measures to raise awareness in children with pleural effusion, the basis for the clinical diagnosis and treatment.Subjects and methods:The study is January 2008 -2010 in pediatric hospital in Shandong Provincial Hospital,55 patients with pleural effusion in children,34 males and 21 females, male: female was 1.6:1, age 4 months to 12 years old, mean age 4.4±2.9 years.One<1 year old in 8 cases,1-3 years old in 16 cases,4-6 years old in 21 cases,7-12 years old in 10 cases. Methods for the clinical symptoms of pleural effusion in children, signs, laboratory tests (including blood culture, sputum culture, pleural effusion culture, tuberculosis antibody, Mycoplasma pneumoniae antibody, PPD test and other conventional pathogen detection and pleural fluid, blood, liver function, serum creatine kinase, C-reactive protein, erythrocyte sedimentation rate and other tests), imaging studies (including chest CT or chest X-ray examination), treatment (including control of infection, chest tube washing and flushing urokinase etc.) to collect clinical data were retrospectively analyzed.Results:55 patients with pleural effusion in hospitalized patients, infection with pleural effusion in 49 cases (89.1%), in which mycoplasma infection in 27 cases (49.1%), bacterial infection in 17 cases (30.1%) and tuberculosis infection in 5 cases (9.1%); non-infectious pleural effusion in 6 patients (10.9%), of which 3 cases of malignant tumors (5.5%), including 2 cases of leukemia, lymphoma,1 case; nephrotic syndrome in 2 cases (3.6%), Kawasaki disease in 1 case (1.8%). Infectious causes of pleural effusion are different in different age groups, children over the age of 3 to mycoplasma infection more common, compared with≤3 years old group were significantly different, (x2=17.91, P<0.01), clinical manifestations of high fever, heat-way long, irritating cough, Mycoplasma pneumoniae antibody titers increased significantly, combined with pneumonia is characterized by; In the 3 years of age to bacterial infection common in children with> 3 years old children with significant difference compared (x2=9.21, P<0.05), clinical fever cough, white blood cells and C-reactive protein was significantly increased, chest plot purulent fluid was significantly changed, combined with pneumonia is characterized by; tuberculosis infection no significant age difference (x2=2.26, P> 0.05). Common position to the right side pleural effusion.55 cases,46 children with pleural puncture fluid routine biochemical tests, consistent with effusion in 45 cases, consistent with leakage of fluid to change in 1 case; 42 patients with parapneumonic pleural effusion, pleural effusion was yellow, with floc or clots; malignant pleural effusion in 3 cases, as bloody pleural effusion. Of the pleural fluid cells in bacterial pleural effusions highest classification to multi-core cell-based, followed by Mycoplasma pleural effusion, as single core or multicore-based; ADA in tuberculous pleural effusions and Mycoplasma significantly higher. Pathogenic examination: serum antibody≥1:160 Mycoplasma pneumoniae in 4 cases, Mycoplasma pneumoniae antibody> 1:320 in 2 cases, Mycoplasma pneumoniae antibody> 1:640 in 3 cases, Mycoplasma pneumoniae antibody≥1:1280 for the 18 cases; PPD test was positive in 2 cases,1 case of tuberculosis antibody; Sputum culture positive in 4 cases,3 cases of Streptococcus pneumoniae, Klebsiella pneumoniae in 1 case; blood culture positive in 2 cases,1 case of Staphylococcus aureus, Streptococcus pneumoniae in 1 case. Pleural effusion culture positive in 9 cases,2 cases of Staphylococcus aureus, Streptococcus pneumoniae in 5 cases,1 case of Klebsiella pneumoniae, Pseudomonas aeruginosa in 1 case.49 cases of infection in children with pleural effusion in 5 cases of tuberculous pleural effusion transfer specialist hospital treatment.44 cases the patients were given anti-infection and symptomatic and supportive treatment.6 cases without thoracic catheter, early onset in 5 cases, a small pleural effusion, pleural effusion absorption after treatment; 1 patient outside the hospital for a long time, chest fiber increased, less pleural effusion, chest tube is not suitable for transfer surgery.38 cases given to the chest tube, of which 12 patients were given sodium bicarbonate, saline irrigation treatment, pleural effusion completely absorbed; 26 cases due to pleural fiber increased, the formation of fluid inclusions and multi-room, while giving the urokinase in normal saline flush treatment,22 patients with symptomatic improvement in absorption of pleural fluid in 3 cases pleural decortication fiberboard, a routine lobectomy.44 cases were clinically cured patients.Conclusion:The etiology of pleural effusion in children with infections mainly infected with mycoplasma, bacteria, tuberculosis, as the three main reasons. Different age groups due to a difference of pleural effusion, pleural effusion mycoplasma infection in preschool and school-age children more common, more common bacteria in infants and young children, no age difference between TB infection. Pathogen detection of pleural effusion such as blood, sputum and pleural effusion develop, tuberculosis antibody detection of Mycoplasma pneumoniae antibody, PPD test and routine check-ups help to pleural effusion pleural effusion of different etiology and differential diagnosis. Mainly in the right pleural effusion, which may be related to the anatomical characteristics of the lower respiratory tract. Chest tube and urokinase irrigation for the treatment of children with pleural effusion.
|