Chronic pneumonia in children
Introduction
Introduction to chronic pneumonia in children Pediatric lung inflammation in children with chronic pneumonia for more than 3 months. In recent years, the mortality rate of acute pneumonia in children is decreasing, but it is not uncommon for children with severe pneumonia to recover completely, relapse and become chronic pneumonia. Chronic pneumonia is characterized by periodic recurrence and deterioration, and it is wavy. Once it occurs, it often affects the growth and development of children. Therefore, it is very important to prevent and treat chronic pneumonia in children. basic knowledge The proportion of illness: 70% Susceptible people: children Mode of infection: non-infectious Complications: emphysema, chronic pulmonary heart disease, anemia
Cause
Causes of chronic pneumonia in children
Nutritional diseases (15%):
Various nutritional diseases such as malnutrition, iron deficiency anemia, vitamin D deficiency rickets, etc., often combined with immune function reduction and prone to pulmonary infection, and often difficult to treat, vitamin (such as vitamin A) deficiency, trace elements Patients with deficiency (zinc, iron) and other diseases are prone to pneumonia and recurrent, difficult to control. When pneumonia occurs in children with congenital heart disease or tuberculosis, it is prone to prolonged disease.
Foreign body in the respiratory tract (25%):
Foreign bodies deep into the bronchus, especially foreign bodies that lack irritating and do not produce acute fever (such as jujube nucleus), can be ignored and remain in the lungs for a long time, forming chronic pneumonia.
Virus infection (25%):
Viral infection causes interstitial pneumonia and easily evolves into chronic pneumonia. Repeated upper respiratory tract infections or bronchitis and chronic sinusitis are all causes of chronic pneumonia.
Immune Deficiency (10%):
Including body fluids and cellular immunodeficiency, lack of complement and defects in white blood cell phagocytosis, can cause recurrent pneumonia, and finally become chronic.
Ciliary dysfunction (10%):
Primary or secondary respiratory cilia morphology and dysfunction can cause chronic inflammation of the lungs.
Pathogenesis
Inflammatory lesions can invade bronchial, alveolar, interstitial tissues and blood vessels at all levels, especially in the inflammation of the interstitial tissue. Each episode has progressed, causing the bronchial wall to break the elastic fibers and eventually causing stenosis due to fibrosis. At the same time, due to secretions blocking the lumen, atelectasis occurs, resulting in bronchiectasis. Due to the destruction of the bronchial wall and alveolar wall, air is scattered through the lymphatic vessels and enters the interstitial space, which can form interstitial emphysema and local blood vessels. Proliferative inflammation also occurs in the lymphatic vessels, the wall is thickened, and the lumen is narrow.
Prevention
Prevention of chronic pneumonia in children
The recovery of pathology of acute pneumonia is later than that of clinical recovery. Therefore, during the recovery period of severe pneumonia, physical therapy and gymnastics should be carried out, and rickets and malnutrition should be actively treated, and follow-up and continued treatment after discharge should be completed until it is completely cured. In addition, infants In early childhood, we should try to prevent measles, whooping cough, influenza and adenovirus infection. For chronic sinusitis and recurrent bronchitis, we should also actively prevent and treat it. Children with immunodeficiency can use immune-boosting therapy, and choose human blood according to the specific situation. Gamma globulin, transfer factor, thymosin or Chinese medicine treatment, if necessary, bone marrow transplantation can be used to rebuild immune function, prevention and treatment of repeated infections and chronic pneumonia.
Complication
Chronic pneumonia complications in children Complications emphysema chronic pulmonary heart disease anemia
Emphysema, pulmonary insufficiency, pulmonary heart disease and liver dysfunction, and anemia.
Symptom
Symptoms of chronic pneumonia in children Common symptoms Leukocytosis, dyspnea, dyspnea, erythrocyte sedimentation rate, asthma, bronchial purulent secretion, hyperventilation, clubbing (toe), chest deformation, facial edema
Chronic pneumonia is characterized by periodic recurrence and deterioration, which is wavy. Due to the age of the lesion, age and individual, the symptoms are various. During the quiescent period, the body temperature is normal, no obvious signs, almost no cough, but running. It is easy to pant when going upstairs, often accompanied by pulmonary insufficiency during the deterioration, cyanosis and difficulty in breathing, and due to decreased vital capacity and respiratory reserve and shortened breath holding time, the external respiratory dysfunction caused by hyperventilation, the improvement is slow after the deterioration , often cough, and even facial edema, cyanosis, thoracic deformation and clubbing, toe, due to emphysema, pulmonary insufficiency caused by increased lung circulation resistance, increased right heart burden, can occur in six months to two years of pulmonary origin Heart disease, there may also be liver dysfunction, increased white blood cells, and moderate erythrocyte sedimentation rate.
Examine
Examination of chronic pneumonia in children
1. Blood: increased white blood cells, increased neutrophils, anemia.
2. Blood biochemistry: ESR increases, liver function is impaired, vitamins, elements are lacking, and immune function is low.
3. Pathogen examination: use throat swab culture, sputum culture, bronchoalveolar lavage, lung puncture culture, virus isolation, immunological examination and PCR technology to find the pathogen.
4. X-ray: chest X-ray shows that the lungs in the lower and lung areas of the two lungs can be honeycombed, with vesicular emphysema, and also with substantial inflammatory lesions. Increase, with the development of the lesion can also occur X-ray signs of bronchial dilatation, right ventricular hypertrophy and pulmonary artery segmentation and other pulmonary heart disease.
5. Electrocardiogram: When there is pulmonary heart disease, the electrocardiogram shows a clockwise shift, the P wave is high and sharp, and the QRS complex wave mostly shows changes in the right ventricular hypertrophy.
6. Conditional bronchoscopy, chest CT, lung biopsy and other tests.
Diagnosis
Diagnosis and diagnosis of chronic pneumonia in children
diagnosis
The history of the disease is extremely important, often with sinusitis, bronchitis or pneumonia, or measles, whooping cough, influenza or adenovirus pneumonia. The diagnosis needs to be combined with medical history, symptoms and X-ray examination. As for the diagnosis of common pneumonia, chronic pneumonia needs to be diagnosed from medical history, clinical symptoms, signs and chest X-ray examinations. Because different types of chronic pneumonia have their own characteristics, they should also consider their specific characteristics when they are diagnosed. It is proposed that the principle of treatment of pneumonia caused by different pathogens is completely different. Therefore, the pathogenic microorganisms that identify pneumonia are important issues that cannot be ignored in the diagnosis. Therefore, the pathogen should be identified before the treatment of pneumonia in order to select drugs.
Differential diagnosis
Pay special attention to the identification of tuberculosis. The history of repeated infections of the upper and lower respiratory tract infections or infectious diseases, and the discharge of pus-like sputum are more common in chronic pneumonia. Tuberculin test and X-ray examination, tuberculosis enters the human body and is swallowed by macrophages. The presence of bacteria in the cells and the host immune response caused by long-term survival are the determining factors affecting the onset, disease process and outcome. The hilar and paratracheal lymph nodes can assist in diagnosis.
