acute pneumonia
Introduction
Introduction to acute pneumonia Acute pneumonia is the most common respiratory disease in children. It is easy to occur in all seasons. Infants and young children under 3 years old have more pneumonia in winter and spring. If the treatment is not thorough, it is easy to recurrent, causing a variety of serious complications, affecting the child's development. Pediatric pneumonia clinical manifestations of fever, cough, shortness of breath, difficulty breathing and fine wet rales in the lungs, but also have no fever and cough and severe. Pediatric pneumonia has typical symptoms, but also atypical, neonatal pneumonia is particularly atypical. Pneumonia caused by bacteria and viruses is the most common. Vaccination in children can now be prevented by vaccines. basic knowledge The proportion of sickness: 0.1% - 0.25% Susceptible people: multiple children Mode of infection: some acute pneumonia can be spread by droplets Complications: respiratory acidosis shock
Cause
Cause of acute pneumonia
1. Pathogenic microorganism infection
The vast majority of acute pneumonia is infectious pneumonia caused by various microorganisms, and its pathogens include bacteria, viruses, chlamydia, mycoplasma, rickettsia and parasites. Acute inflammation of acute pneumonia is a common clinical infectious disease. According to anatomical classification, pneumonia can be divided into large leaf, lobular and interstitial. In recent years, due to the widespread use of antibiotics, clinically, mild or atypical pneumonia is common, and pneumonia with whole leaf consolidation is rare.
2, low immunity
The immune defense functions of normal lungs, such as filtration and humidification of inhaled gases, epiglottic reflex and cough reflex, bronchial cilia mucus excretion, humoral and cellular immune functions, and phagocytosis of neutrophils, can make trachea, The bronchial and alveolar tissues remain sterile. Oral inhalation of oropharyngeal colonization is the most important pathogenesis of acute bacterial pneumonia. The colony of the oropharynx of normal people includes many pathogenic bacteria that can cause pneumonia, when the body's immune function is low or the pathogen enters the lower respiratory tract. When the virulence is strong or the amount is high, pneumonia will follow.
3, children's respiratory physiology and anatomical factors
Nasopharyngeal, tracheal and bronchoconstriction, less mucus secretion, poor ciliary movement, incomplete differentiation of lung tissue, inferior development of elastic fibers, poor compensatory capacity, less alveolar and strong interstitial development, so less gas and less blood, these characteristics in infants The performance of the period is more prominent. In addition, the immune function is not fully developed, so it is easy to suffer from tracheal pneumonia.
Prevention
Acute pneumonia prevention
Prevention of acute pneumonia should pay attention to the following aspects:
1, according to the weather changes, pay attention to cold and warm.
2. Maintain air circulation in the living and working environment.
3, pay attention to personal hygiene, wash hands frequently.
4. Strengthen exercise and enhance physical fitness.
5. Avoid smoking and drink less.
6. Less public places and less participation in group activities during the epidemic period. Those who are in contact with the patient should wear masks.
Complication
Acute pneumonia complications Complications, respiratory acidosis, shock
If the disease does not achieve timely and effective treatment measures may be complicated by lung abscess, respiratory acidosis, convulsions and even death.
Symptom
Symptoms of acute pneumonia Common symptoms Cough, persistent fever, wilting, irritability, restlessness, pale, breathless, nose, fan, nail bed, hairpin, cyanosis
Due to different pathogens and body reactions, clinical manifestations vary in severity.
First, the onset of mild bronchial pneumonia can be acute and slow, generally have symptoms of upper respiratory tract infection, but it can also suddenly occur.
1, the fever is mostly higher, around 39-40 °C, irregular, hot type is uncertain, mostly relaxation heat type, infants suffering from rickets, malnutrition, body temperature can not be high; newborns with pneumonia, can appear body temperature Not rising.
2, cough is the early symptoms of the disease, starting with frequent stimuli dry cough, followed by snoring in the throat, cough can be accompanied by vomiting, licking milk.
3, the breathing surface is increased quickly, the nose fan, some children with perioral, nails slightly bun.
4, the early signs of the lungs are not obvious, only the breath sounds rough or the breath sounds are slightly reduced, can be heard after a few days. The medium and fine wet rales are especially dense and wet, and the back of the lungs and the spine are denser and deeper. The deep inhalation is more clear. When the lung lesions are fused, the vocal fibrillation can be enhanced and the voiced voice can be diagnosed. Auscultation of respiratory sounds such as weakened or tubular breathing sounds.
In addition to respiratory symptoms, children may be accompanied by general symptoms such as listlessness, irritability, loss of appetite, cramps, and diarrhea. If the treatment is timely and appropriate, it will recover within two weeks.
Second, severe pneumonia in addition to mild pneumonia, the performance of persistent high fever systemic poisoning is severe, and accompanied by other organ damage.
1. Children with respiratory symptoms show superficial and rapid breathing, up to 80 times per minute, and the nose flaps are obviously moving. When breathing, the upper sternal fossa, the supraclavicular fossa, the intercostal space and the xiphoid are obviously depressed, called the three concave sign. Even worse, a nodular breath or exhalation is formed, and the face and the extremities are obviously cyanotic, and even the face is pale or gray. Both lungs can smell dense and dense wet rales.
2, circulatory system symptoms of infant pneumonia often accompanied by cardiac insufficiency. Expressed as:
(1) Sudden breathing is aggravated and breathing is significantly increased, exceeding 60 beats/min. Can not be explained by respiratory diseases.
(2) Suddenly irritated, pale or cyanosis, still not relieved by oxygen and sedative treatment.
(3) The heart rate suddenly increases, the baby is more than 160 beats/min, and the newborn is more than 180 beats/min. It cannot be explained by the increase of body temperature and lack of oxygen in breathing difficulties.
(4) The heart sound is low and blunt or there is a galloping, heart enlargement, and the like.
(5) The sound of the liver is increased by 1.5cm in a short time.
(6) Sudden increase in lung rales, may have jugular vein engorgement, facial swelling of the limbs, less urine.
3, nervous system symptoms
(1) irritability, lethargy, gaze, strabismus, eyelids.
(2) lethargic, even coma, convulsions.
(3) bulbar conjunctival edema.
(4) The pupil changes, and the response to light is slow or disappears.
(5) The breathing rhythm is not complete.
(6) The anterior cardia swells, there are meningeal stimuli, cerebrospinal fluid in addition to increased pressure, the other is normally called toxic encephalopathy, severe cases of higher intracranial pressure, cerebral palsy.
4, digestive system symptoms of children with decreased appetite, vomiting, diarrhea, bloating, severe vomit is brown or blood in the stool, bowel sounds disappear, toxic intestinal paralysis, and toxic hepatitis.
5, there may be metabolic acidosis, respiratory acidosis, etc., mixed acidosis may also occur. In addition, DIC and so on can still occur.
Examine
Examination of acute pneumonia
1. In the absence of experimental diagnostic methods, comprehensive analysis based on clinical manifestations, signs, X-ray changes, complications and response to treatment, to estimate the etiology of pneumonia.
2. The following tests may have certain reference significance for identifying bacterial or viral infections.
(1) White blood cell examination
(2) C-reactive protein test (CRP)
(3) Cell pathogen examination
(4) Virus pathogen examination
Diagnosis
Diagnosis and differentiation of acute pneumonia
diagnosis
It can be diagnosed by clinical signs and laboratory tests.
Differential diagnosis
1. Bronchitis
The systemic symptoms are mild, generally no dyspnea and hypoxic symptoms, the lungs can smell dry rales and medium coarse wet rales, not fixed, often disappear with cough or body position changes.
2, acute miliary tuberculosis
Sudden onset of children often accompanied by high fever, chills, general malaise, shortness of breath, cyanosis and other symptoms of systemic poisoning, similar to bronchitis, but the lungs often have no obvious signs, or there are fine wet rales, scattered in both lungs, mostly in Found at the end of inhalation. X-ray findings are also similar to bronchial pneumonia. According to the history of tuberculosis exposure, clinical symptoms, positive tuberculin test, increased erythrocyte sedimentation rate, sputum or gastric lavage fluid can be identified by the characteristics of follow-up observation of tuberculosis and X-ray.
3, cheese pneumonia
Most of these lesions are produced in children with weak or low resistance. X-rays show dense consolidation in most of the lung segments and even a lobe. The contours are blurred and usually a more translucent liquefied area is visible. Light-transparent cavity. Combined with medical history, tuberculin test, etc., easy to identify with bronchial pneumonia.
4, bronchial foreign body
There is a history of foreign body inhalation, or a history of cough. The clinical is light and heavy, and the duration of the disease varies. Patients with secondary infections may have repeated fever, cough, lung audible and wet rales similar to pneumonia. Sometimes auscultation and tracheal slap sounds may be helpful in diagnosis, but the diagnosis is confirmed by fiber-optic patency.
5, bronchiolitis
It is very similar to acute pneumonia, but the disease is mainly asthmatic. Both lungs can smell a wide range of wheezing sounds and fine wet rales. The children with severe disease have obvious hypoxia. The X-ray only shows that the two lungs have enhanced transmittance, the diaphragm is decreased, and the transient emphysema changes. A few sick children have a little spotty shadow.
