Bronchopneumonia

Introduction to Bronchial Pneum Bronchial pneumonia, also known as lobular pneumonia, is a major common disease in children, especially in infants and young children, and is the leading cause of death in infancy. Pneumonia occurs mostly during the cold seasons of winter and spring and sudden changes in climate, but summer is no exception. Even some southern China have more incidences in the summer, and the immunity is not persistent after the illness, and it is easy to be infected again. Bronchopneumonia is caused by bacteria or viruses. Bronchial pneumonia occurs mostly in the winter and spring seasons and when the climate suddenly changes, some southern China have more incidences in summer. Indoor living is crowded, poor ventilation, air pollution, and more pathogenic microorganisms, which are prone to pneumonia. Bronchial pneumonia can be caused by bacteria or viruses. basic knowledge The proportion of illness: 3% Susceptible people: good for children Mode of infection: non-infectious Complications: emphysema, atelectasis, bronchiectasis, lung abscess, pericarditis, respiratory failure, lactic acidosis

Cause of bronchial pneumonia

Pneumonia occurs mostly during the winter and spring seasons and when the climate suddenly changes, some southern China have more incidences in the summer. Indoor living is crowded, poor ventilation, air pollution, and more pathogenic microorganisms, which are prone to pneumonia. Bronchial pneumonia can be caused by bacteria or viruses.

Bacterial infection (30%):

Pneumonia is easy to occur in infants and young children due to the physiological and anatomical features of the respiratory system: such as tracheobronchial stenosis, less mucus secretion, poor ciliary movement, poor development of lung elastic tissue, rich blood vessels, easy congestion, strong interstitial development, and number of alveoli Less, the lungs contain less gas, easy to block for mucus. There are also weaknesses in immunology at this age, and the defense function has not yet fully developed, and it is prone to infectious diseases, malnutrition and other diseases. These internal factors not only make infants and young children prone to pneumonia and are more serious. The immunity of infants under 1 year old is very poor. Therefore, pneumonia is easy to spread and spread and spread to both lungs. The age of older and stronger children is gradually becoming more mature and limited. The ability to infect is enhanced, and pneumonia often has larger lesions. If it is limited to one leaf, it is big leaf pneumonia.

Pathogens (30%):

All pathogens that cause upper respiratory tract infection can induce bronchopneumonia (Bronchopneumonia) but mainly bacteria and viruses. Among them, Streptococcus pneumoniae RSV is the most common. After the 1990s, the United States and other developed countries are generally vaccinated with Haemophilus influenzae type b (Hib) vaccine, and the pneumonia caused by Haemophilus influenzae has been significantly reduced. Most of the bronchial pneumonia is caused by pneumococcal bacteria, which accounts for 90% of bacterial pneumonia. Above, other bacteria such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Pseudomonas aeruginosa are less common. At least 86 different serotypes of pneumococci are sensitive to penicillin. Therefore, the current classification is less common for treatment. The pneumococcal type is a virulence pneumococcal strain of type 14181923, which has a capsule-specific polysaccharide and thus resists phagocytosis, while an asymptomatic pneumococcal pathogenic carrier plays a role in spreading infection compared with pneumonia. The patient's more important role, the disease is generally distributed but sometimes in the group care institutions can have beta-hemolytic streptococcus, often in the measles or pertussis course as a secondary infection coagulase-positive Staphylococcus aureus, is a child A common pathogen of severe pneumonia but Staphylococcus aureus pneumonia. In recent years, there has been an increase in the incidence of pneumonia caused by influenza bacilli, which is often secondary to bronchitis bronchiolitis or sepsis, which is more common before the age of three. Pneumonia caused by Escherichia coli is mainly seen in newborns and malnourished babies. However, in the case of a large number of antibiotics in recent years, this disease is similar to staphylococcal pneumonia. It can be secondary to other serious diseases. Pneumococcal pneumonia and Pseudomonas aeruginosa pneumonia are rare, generally secondary interstitial bronchus. Most of the pneumonia is caused by the virus, mainly the adenovirus respiratory syncytial virus, influenza virus, parainfluenza virus, measles virus and other measles diseases, often accompanied by bacterial pneumonia, but the measles virus itself can also cause pneumonia, which has been from the early stage of measles pneumonia without bacterial infection. The measles virus interstitial bronchopneumonia isolated from the lungs of the deceased may also be caused by certain types of M. globosa and M. pneumoniae.

Bronchial pneumonia prevention

In order to prevent pneumonia, the following measures should be emphasized.

1. Strengthen nursing and physical exercise: pay attention to nutrition during infancy, add non-staple food in time, cultivate good diet and hygienic habits, and get more sun exposure to prevent rickets and malnutrition. It is the key to prevent severe pneumonia. Ventilation, often in outdoor activities or sleeping outdoors, so that the body is resistant to cold and adapt to changes in environmental temperature, it is not easy to have respiratory infections and pneumonia.

2, to prevent acute respiratory infections and respiratory infections: for infants and young children should be able to avoid contact with respiratory infections, especially weak infants easily develop into pneumonia after infection, pay attention to prevention and treatment of respiratory infections that are prone to severe pneumonia, such as whooping cough, Influenza, adenovirus and measles infections, especially for immunodeficiency diseases or children with immunosuppressive agents.

3, prevention of complications and secondary infections: infants who have pneumonia, weak resistance, easy to get rid of his disease, should actively prevent complications that may cause serious prognosis, such as empyema, pus gas chest, etc., should be different in the ward The children of the pathogen should be isolated as much as possible. The recovery period and the newly admitted children should also be separated as much as possible. When the medical staff contact different children, they should pay attention to the disinfection and isolation operation. In recent years, it has been useful to reduce the pathogens in the air by using Chinese medicine such as Atractylodes lancea and Ai Ye. This method can be used to prevent cross-infection.

Bronchial pneumonia complications Complications emphysema, atelectasis, bronchiectasis, lung abscess, pericarditis, respiratory failure, lactic acidosis

Complications of early correct treatment are rare. The most common complications of bronchial pneumonia are different degrees of emphysema or atelectasis, which gradually disappear with the cure of pneumonia. Long-term atelectasis or recurrent pneumonia can lead to bronchi. Dilated or pulmonary heart disease, bacterial pneumonia pay attention to empyema, pus pneumothorax, lung abscess, pericarditis and sepsis, etc., more common in Staphylococcus aureus pneumonia, some pneumonia can also be complicated by toxic encephalopathy, a small number of severe pneumonia Children may also have diffuse intravascular coagulation, gastrointestinal bleeding or jaundice. Some children with pneumonia develop rapidly into respiratory failure and are life-threatening. Some children with severe pneumonia can cause water and electrolyte disorders, especially with hyponatremia. Acidosis and lactic acidosis.

Symptoms of bronchial pneumonia Common symptoms Irritability, difficulty breathing, lung hyperinflation, heart failure, nasal wing, cough, multiple cyanosis, pale pleural effusion, convulsion

According to acute onset, respiratory symptoms and signs, general clinical diagnosis is not difficult, if necessary, can do fluoroscopy, chest X-ray, or throat test, tracheal secretion bacterial culture or virus isolation, other pathogens including antigens and antibodies Detection, white blood cells increased significantly and neutrophils, serum C-reactive protein increased the diagnosis of bacterial pneumonia, white blood cells decreased or normal, it is mostly viral pneumonia.

1, the general symptoms: rapid onset or slow onset, sudden onset of fever, refusal or vomiting, lethargy or irritability, wheezing and other symptoms, before the onset can have mild upper respiratory tract infection for several days, early body temperature is more than 38 ~ 39 ° C, can also be as high as 40 ° C, mostly for the type or regular fever. Most of the weak babies are slow onset, fever is not high, cough and lung signs are not obvious, common refusal to eat, breast milk, vomiting or difficulty breathing.

2, the symptoms and signs of the respiratory system: cough and pharyngeal snoring, generally early is very obvious, breathing increased, up to 40 to 80 times per minute, so that the ratio of breathing and pulse increased from 1:4 to 1:2 Left and right, common breathing difficulties, severe people have a snoring when exhaling, nose flapping, three concave signs, mouth Zhou Gong approved a blue purple, some children head backwards to make the breathing smooth, if the child passively bend forward When the neck is strong, the resistance is obvious. This phenomenon should be distinguished from the neck muscle rigidity.

Chest signs are often not obvious in the early stage, or only the breath sounds become thicker or slightly lower. Later, you can hear the middle, rough and wet rales, and have a slight percussion dullness. After a few days, you can smell the fine wet rales or sputum sounds. When the matter is enlarged, a tubular breath sound can be heard, and there is a percussive voiced sound. If one side of the lung is found to have a percussive sound or/and the breath sound disappears, consideration should be given to the presence or absence of pleural effusion or empyema.

The WHO Children's Acute Respiratory Infections Prevention and Control Plan emphasizes that respiratory acceleration is the main manifestation of pneumonia. Shortness of breath refers to: infants < 2 months old, breathing 60 times; 2 to 12 months old, breathing 50 times; 1 to 5 years old Respiratory 40 times, severe pneumonia indications are irritating or lethargy, refusal to eat, lower chest wall depression and purpura, which provides a simple and feasible diagnostic basis for primary medical staff and primary health care workers, and is worth promoting.

3, the symptoms and signs of other systems: more common in critically ill patients.

(1) Digestive tract symptoms: Infants and young children suffering from pneumonia, often accompanied by vomiting, diarrhea, abdominal pain and other gastrointestinal symptoms, vomiting often occurs after a strong cough, when the abdominal distension is severe, causing the diaphragm to rise, oppress the chest, more difficult to breathe, Sometimes lower lobe pneumonia can cause acute abdominal pain and should be differentiated from abdominal surgery dysentery.

(2) Circulatory system symptoms: children with heavier pneumonia may have pulse acceleration, 160 to 200 beats per minute or more per minute, which is not commensurate with the increase in body temperature and dyspnea, and the liver is significantly increased or increased in a short time. His face is pale, his lips are bun, or his face, his limbs are swollen, and his urine is less. It is a sign of congestive heart failure. Sometimes his limbs are cold, his mouth is gray, and his pulse is weak. He is terminal circulatory failure.

(3) symptoms of the nervous system: common irritability, lethargy, or alternating between the two, infants are prone to convulsions, mostly due to high fever or calcium deficiency, such as convulsions while apparently lethargy or irritability, and persistent coma, and even Occurrence of myotonic tendon, hemiplegia or other brain signs may be complicated by central nervous system diseases such as meningoencephalitis, toxic or hypoxic encephalopathy.

4, X-ray virus: Take bronchial pneumonia as an example to describe the X-ray performance, the cause is different, the changes on the X-ray show that there are common points, but also have their own characteristics.

(1) Morphology of the lesion: bronchial pneumonia is mainly caused by inflammatory exudation in the alveoli, and it spreads along the bronchus and invades the lobules, lung segments or large leaves. X-ray signs can be expressed as non-specific small patchy lung parenchymal infiltration shadows. With two lungs, the heart palpitations and the middle zone are more common in infants and young children. Small patch lesions can be partially fused together to form large infiltrates, even in the form of segments or large leaf pneumonia. When there are more small round lesions in the lesion, it should be considered that there may be a suppurative infection.

(2) Atelectasis and emphysema sign: due to bronchial endocrine and pneumonia obstruction obstruction, can produce atelectasis or emphysema, emphysema in children with pneumonia is one of the early common signs, in the course of disease The chance of bubbling emphysema and mediastinal emphysema is also more common than in adults.

(3) Pulmonary interstitial X-ray signs: The lung interstitial tissues of infants are well developed. When suffering from bronchial pneumonia, pulmonary interstitial X-ray signs may appear. In common lungs, the internal texture is increased, blurred or strip-like shadows, and even Gathered into a net shape, these interstitial changes are in sharp contrast to the hyperinflation of the lungs in the lungs of the two lungs, and the pulmonary emphysema is caused by influenza virus pneumonia, measles virus pneumonia, and pertussis pneumonia. These X-ray signs can be found in all reactions.

(4) X-ray signs of the hilar: Most of the lymph nodes around the hilar are not swollen or only the shadow of the hilar is deepened, and even around the hilum.

(5) X-ray signs of the pleura: less pleural changes, sometimes one or bilateral pleurisy or pleural effusion.

Although bronchopneumonia of various causes has similarities in X-ray manifestations, it is different. Therefore, it is necessary to master the X-ray manifestations of various pneumonias, and to closely combine clinical symptoms in order to make a correct diagnosis.

5, the general course of disease: after treatment, light cases (generally older and stronger children) mostly recovered within 1 to 2 weeks, severe cases (mostly belong to weaker babies, combined with rickets or various congenital Sexually transmitted diseases) are often prolonged, chest signs disappear slowly, and are prone to recurrence, and the course of disease can be prolonged when complications occur.

Examination of bronchial pneumonia

1, blood

The total number of white blood cells in children with bacterial pneumonia is mostly increased, generally up to (15 ~ 30) × 109L, even up to 50 × 109L, granulocytes are 0.60 ~ 0.90, but in severe S. aureus or Gram-negative bacillus pneumonia White blood cells may not be high or decreased. When viral pneumonia is present, the number of white blood cells is mostly low.

2, bacterial examination

It is difficult to make a bacterial pathogen that accurately reflects lung lesions. The bacteriological examination of lung puncture is the most reliable and is considered to be the gold standard, but it is difficult for doctors and children to accept. The results of pharyngeal culture generally do not reflect the lower respiratory tract. Disease, sputum culture, especially through fiberoptic bronchoscopy for secretion culture is more reliable, but it may also be contaminated, bacterial pneumonia bacteremia is only transient, coupled with serious abuse of antibiotics in China and some problems in culture methods The blood culture is only 10% positive. The antibody detection is only retrospective, and there are individual differences. The detection of bacterial antigen for the diagnosis of pneumonia in children has developed rapidly in recent years. As a quick and simple diagnostic method, it has certain promotion value. Positive blood and urine antigens Although it is not certain that the pathogen components must come from the lungs, it indicates that there is a corresponding bacterial infection in the body.

3. Other pathogens

Virological examination is the most reliable, reproducible and specific, but it takes a long time, the operation is cumbersome, requires certain technical and equipment conditions, serological examination of specific antibodies has diagnostic significance, RSV infection can be neutralized and Enzyme-linked immunosorbent assay (ELISA); adenovirus infection is generally diagnosed by complement-binding assay, neutralization assay, immunofluorescence technique and ELISA. At present, micro-hemagglutination inhibition test is more common, and the operation is simple; Inhibition test, nasal virus and coronavirus infection can be used in neutralization test, where the recovery period serum antibody is 4 times or more than the acute phase has diagnostic value, the virus specific rapid diagnosis method is currently applied more immunofluorescence technology Electron microscopy technology and immunoenzymatic technology, electron microscopy technology is complex, high cost, difficult to promote; immune enzyme technology is commonly used ELISA, enzyme-linked fluorescence technology, immunostaining method, etc., in addition to radioimmunoassay using isotope-labeled antibodies, recent Years of detection of viral DNA in specimens by polymerase chain reaction (PCR) Off, diagnosis of mycoplasma disease nonspecific agglutination, only as a reference; specific diagnostic method for the determination of serum antibody and mycoplasma and PCR.

4, blood gas analysis

Blood lactate kimono ion gap (AG) determination, for patients with severe pneumonia with respiratory failure, can understand the lack of oxygen and severity, the type and extent of electrolyte and acid-base imbalance, help diagnosis and prognosis .

Diagnosis of bronchial pneumonia

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

1. The number of fever days of bacterial pneumonia can be affected by treatment.

2, influenza virus pneumonia clinically seen adenovirus pneumonia, but lighter.

3, the diagnosis of mycoplasmal pneumonia often uses positive test of condensed concentration test and serum antibody test.

Differential diagnosis :

In infancy, it is often necessary to distinguish between tuberculosis and other conditions of dyspnea:

1, tuberculosis: identification should pay attention to the history of family tuberculosis, tuberculin test and long-term clinical observation, tuberculosis X-ray mostly see lung lesions and clinical symptoms are less, the two are often disproportionate.

2, other conditions of dyspnea: the disease of the throat is generally hoarseness and croup, such as children with deeper breathing, should consider whether there is acidosis, asthma breathing is difficult to exhale, baby babies Although tachycardia has symptoms such as shortness of breath and cyanosis, it has the characteristics of tachycardia and can be checked by electrocardiogram.

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