百日咳发病及并发感染情况分析

Analysis of the Incidence and Concurrent Infection of Pertussis

摘要: 目的：分析近期百日咳的临床发病特征、并发症、合并其他病原感染及预后情况，对提高百日咳的发病特点、病情变化、并发感染、合并症及预后的认识提供参考。方法：收集病历资料完整的96例百日咳患儿为研究对象。按年龄分为0~3个月，3.1月~1岁，1.1~4岁，4.1~10岁。采用回顾性分析比较主要临床症状与体征、实验室检查、影像学检查、病原学检查、并发症、治疗及病情恢复情况。结果：96例百日咳患儿中，男52例(54.2%)，女44例(45.8%)，>3月龄的64例(66.7%)，≤3月龄的32例(33.3%)，发病季节1~3月份32例(33.3%)，4~6月份18例(18.7%)，7~9月份11例(11.5%)，10~12月份35例(36.5%)。城市38例(39.6%)，农村58例(60.4%)，有明确接触史的5例(5.2%)，行免疫接种的53例(55.2%)。各年龄组鸡鸣音、声音嘶哑、呕吐、窒息、肺部啰音无差异，青紫、发热有差异。未接种疫苗的患儿鸡鸣样回声、青紫的发生较已接种疫苗明显升高，而痉咳性咳嗽、声嘶、呕吐、窒息的发生与已接种疫苗的患儿无明显差异，未免疫接种患儿痉咳时间延长。白细胞计数和淋巴细胞比率在各年龄组间无明显差异。PT-IgM阳性的37例(38.5%)，各年龄组比较P < 0.001；PT-IgG阳性的29例(30.2%)，PCR阳性的87例(90.6%)，各年龄组比较无差异。支气管炎27例(28.1%)，肺炎62例(64.6%)，肺实变6例(6.3%)，肺不张4例(4.2%)，局限性肺气肿11例(11.5%)，各年龄组比较无差异。并发感染病原体中以支原体、腺病毒、金黄色葡萄球菌、流感嗜血杆菌感染较多，且存在几种病原体混合感染。其他并发症中以心肌损害、肝功能损害、呼吸功能和心功能不全为主。予以红霉素、阿奇霉素治疗，并发肺部与其他病原体感染者联合阿莫西林舒巴坦、美罗培南等治疗，临床治愈91例，好转2例，自动出院3例。平均住院12.4 ± 5.3天。结论：百日咳发病近几年再现，本研究对临床变化、并发症、并发其他病原体感染等进行了分析，对提高百日咳的新发病特点、病情变化、并发感染、并发症的认识提供参考作用。根据临床特点综合分析，利用血清学、百日咳核酸检查确诊，综合治疗，有效治疗并发症是关键。

Abstract: Objective: To investigate the clinical features, complications, merging other pathogen infection and prognosis in recent pertussis, and to provide reference for the understanding of clinical characteristic, condition change, concurrent infection, complications and prognosis of pertussis. Methods: 96 children with pertussis were studied. According to age, patients were divided into 0 - 3 months, 3.1 - 1 years, 1.1 - 4 years, and 4.1 - 10 years. The main clinical symptoms and signs, laboratory examination, imaging examination, pathologic examination, complications, treatment and recovery of the disease were analyzed respectively. Results: In 96 cases of children with whooping cough, male 52 cases (54.2%), female 44 cases (45.8%), 64 cases (66.7%) > 3 months, 32 cases (33.3%) ≤ 3 months, the onset of season, 32 cases (33.3%) in Jan.-Mar., 18 cases (18.7%) in Apr.-June., 11 cases (11.5%) in Jul.-Sep., 35 cases (36.5%) in Oct.-Dec. 38 cases (39.6%) in cities, 58 cases (60.4%) in the rural areas, 5 cases (5.2%) with definite contact history, and 53 cases (55.2%) of immunization. There is no difference in crow echo, raucedo, vomiting, asphyxiation and the lungs rale in every age groups. Unvaccinated children crow echo, cyanoderma occured significantly increased to the vaccinated, but spasm cough, hoarseness, vomiting, asphyxiation has no difference between the vaccination and the unvaccinated, unimmunized children had a prolonged spasm cough. There was no significant difference between white blood cell count and lymphocyte ratio in all age groups. There were 37 cases (38.5%) of PT-IgM positive, and P < 0.001 in age groups, 29 cases (30.2%) of PT-IgG positive and 87 cases (90.6%) of PCR positive, with no difference in age groups. There were 27 cases of bronchitis (28.1%), 62 cases of pneumonia (64.6%), 6 cases of pulmonary consolidation (6.3%), 4 cases of pulmonary atelectasis (4.2%), and 11 cases of localized emphysema (11.5%), were no difference in all age groups. The pathogen of accompanying infection in pertussis was mycoplasma, adenovirus, Staphylococcus aureus haemophilus influenzae. Other main complications were myocardial damage, liver function damage and respiratory cardiac function insufficiency. It was treated with erythromycin and azithromycin, and combined with other infectious agents, adding amoxicillin sulbatam and meropenem. Clinical cure 91 cases, improvement 2 cases, automatic discharge 3 cases. The average hospitalization was 12.4 ± 5.3 days. Conclusion: Pertussis incidence increased in recent years, the study analyzed clinical changes, complications, and other pathogen infection, and to improve understanding of the new pertussis infection characteristics, condition changes, accompanying infection and complications，so that provide reference. According to the comprehensive analysis of the clinical features, diagnosis of serology, pertussis nucleic acid, comprehensive treatment and effective treatment of complications are the key.