pneumonia in children
Introduction
Introduction to children with pneumonia Pediatric pneumonia is a common clinical disease, which is easy to occur in all seasons, especially in winter and spring. If the treatment is not thorough, it is easy to recurrent and affect the child's development. The clinical manifestations of pneumonia in children are fever, cough, difficulty in breathing, and there is also no fever and cough and asthma. The main cause is that children have eaten sweet, salty, fried and other foods, causing food to accumulate and heat inside. Sheng, the occasional encounter with the cold makes the lungs unrecognized, and the two cause pneumonia. basic knowledge The proportion of illness: 0.006% Susceptible people: infants and young children Mode of infection: non-infectious Complications: coma, respiratory failure, atelectasis, atelectasis, emphysema, emphysema, bronchiectasis in children
Cause
Pediatric pneumonia
Bacterial infection (30%):
The prenatal fetus lives in the uterus filled with amniotic fluid, and hypoxia occurs (such as umbilical cord around the neck, fetal heart rate changes, abnormal fetal movement), respiratory movements occur and inhaled amniotic fluid, causing aspiration pneumonia; such as early water breakage, prolonged labor Or in the process of childbirth, inhalation of bacterial contaminated amniotic fluid or birth canal secretions, easy to cause bacterial pneumonia, such as amniotic fluid contaminated by meconium, inhalation of the lungs can cause meconium aspiration pneumonia.
Blood infection (20%):
If there is a person with a child in the child (such as a cold), the child is easily infected with pneumonia. The newborn is infected with pneumonia through blood circulation due to sepsis or umbilical inflammation or enteritis. This infection can be caused by bacteria and is slightly older. In newborns, pneumonia can also be caused by viruses and other microorganisms.
Environmental factors (10%):
Such as sudden changes in the climate, poor ventilation in the living room, air pollution and so on.
Prevention
Pediatric pneumonia prevention
1, indoor air is fresh
Keep your indoor air fresh and quiet and let your child rest.
2, diet and drainage
Eat digestible, high-calorie and vitamin-rich foods on the diet. Soft foods are best for the absorption of the digestive tract. When coughing, you should pat the child's back, which is good for the discharge of sputum. When shooting the back, shoot from the bottom to the top. Don't be too dry in the room. Children should drink water properly to dilute the sputum, which is good for sputum discharge.
3, strengthen the exercise, pay attention to the appropriate increase in clothes
Prevent upper respiratory tract infections, pay attention to strengthen exercise, and choose appropriate exercise methods according to age. When you are outdoors, pay attention to the proper addition of clothes. When the world is catching a cold, don't bring your child to a public place. When someone in the family has a cold, don't touch the child.
4. Enhance the disease resistance of infants and young children
Insist on exercising, enhance disease resistance, and pay attention to climate changes, and increase or decrease clothes for children to prevent colds and colds. Reasonable feeding to prevent malnutrition. Educate children to develop good hygiene habits, not spitting, so that infants and young children can get more sun. Constantly improving the disease resistance of infants and young children is the key to preventing the disease.
Complication
Pediatric pneumonia complications Complications, coma, respiratory failure, atelectasis, pediatric atelectasis, emphysema, pediatric bronchiectasis
Pediatric pneumonia can be quickly recovered if it is found in time and effective treatment, but the following complications are likely to occur in severe cases. If not treated promptly, the prognosis is poor.
1, heart failure: children with irritability, difficulty breathing and cyanosis, heart rate, 180 times / min, shortness of breath, > 60 beats / min, liver enlargement, lower extremity edema, etc., should immediately take measures to control its development, Use cardiotonic, diuretic and other treatments.
2, respiratory failure: children with irritability, difficulty breathing and cyanosis, early breathing, accelerated, slow down, there are changes in breathing and breathing rhythm, heart rate is accelerated or slowed in critical situations, and coma and convulsions can occur.
3, pus pneumothorax: Staphylococcus aureus pneumonia, prone to pus gas chest, at this time, high fever continues to retreat or body temperature decline and then rise again, cough frequently, shortness of breath, can not be lying, one side of the thorium full.
4, hypoxic encephalopathy: pneumonia, difficulty breathing, lack of oxygen, vomiting, headache, lethargy or irritability in children, followed by coma, convulsions, encephalopathy is more acute, fierce, sick and ill, often intertwined with a variety of complications, Mutual influence makes the condition more complicated and the mortality rate is high.
5, toxic shock, sudden increase in body temperature of 40 ~ 41 ° C or sudden drop, chills, pale complexion, irritability or coma, sweating, skin changes in marble pattern, blood pressure decreased or not detected, and multiple organ function changes The symptoms are dangerous.
6, toxic intestinal paralysis: manifested as high abdominal distension, vomiting, constipation and anal can not vent (not fart), abdominal distension oppression of the heart and lungs, making breathing difficulties more serious, at this time, the bread pale gray, abdominal palpation is drum The sound of the bowel sound disappears, and the vomit can be brown or fecal. The x-ray examination reveals that the intestine is dilated, the wall becomes thin and the diaphragm rises, and the gas-liquid plane appears in the intestine.
7, in addition, children with pneumonia can also be complicated by atelectasis, emphysema, pulmonary bleb, bronchiectasis, etc., so that children with pneumonia is a common disease, but also a risk, so parents must pay attention to prevention and care .
Symptom
Symptoms of pneumonia in children Common symptoms High fever, pale, dry, cough, nose, fan, cough, sputum, drowsiness, snoring, loss of appetite, irritability
First, mild bronchial pneumonia.
1. Fever: Most are higher.
2, cough: began as a frequent stimuli dry cough, followed by a snoring sound 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.
In addition to respiratory symptoms, children may be accompanied by general symptoms such as listlessness, irritability, loss of appetite, cramps, and diarrhea.
Second, severe pneumonia: In addition to the increased performance of mild pneumonia, persistent high fever systemic symptoms are severe, and accompanied by other organ damage.
1, respiratory symptoms: breathing superficial, rapid, up to 80 times per minute, nose flapping, there are three concave signs, exhaled phlegm, facial and limbs end of the cyanosis, even pale or gray, both lungs can be heard And intensive fine wet rales.
2, circulatory system symptoms: infant pneumonia often accompanied by cardiac insufficiency.
3, nervous system symptoms: (1) irritability, lethargy, gaze, strabismus, eyeball sputum; (2) lethargy, even coma, convulsions; (3) conjunctival edema; (4) pupil changes, slow response to light or (5) The respiratory rhythm is not complete; (6) The anterior cardia swells, there is a meningeal stimuli, and the cerebrospinal fluid is abnormally called toxic encephalopathy. In severe cases, the intracranial pressure is higher and cerebral palsy may occur.
4, digestive system symptoms: children with decreased appetite, vomiting, diarrhea, abdominal distension, 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.
Examine
Pediatric pneumonia examination
1, white blood cell examination: cell pneumonia, the total number of white blood cells increased, about 15 ~ 20 × 109 / L, severe Staphylococcus aureus pneumonia and influenza bacillus pneumonia, sometimes the total number of white blood cells decreased, the number of white blood cells of viral pneumonia is normal or reduced The proportion of lymphocytes increased and the number of neutrophils did not increase.
2, C-reactive protein test in bacterial infection, sepsis, etc. This value increases, the increase is proportional to the severity of the infection, the virus and mycoplasma infection does not increase.
3. Cell pathogen examination.
4. Virus pathogen examination.
5, chest X-ray examination.
Diagnosis
Diagnosis and diagnosis of pneumonia in children
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Pediatric pneumonia is easily confused with bronchitis, acute miliary tuberculosis, caseous pneumonia, bronchial foreign body, bronchiolitis and other diseases.
1, bronchitis: systemic symptoms are mild, generally no breathing difficulties and hypoxia symptoms, the lungs can be heard and dry rales and medium and coarse wet rales, not fixed, often disappear with cough or body position changes.
2, acute miliary tuberculosis: children with acute onset are 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 have a wet rales, Dispersed in both lungs, mostly found at the end of inhalation, X-ray performance is similar to bronchial pneumonia, according to the history of tuberculosis exposure, clinical symptoms, tuberculin test positive, ESR increased, sputum or gastric lavage detected tuberculosis And the characteristics of the X-ray tracking observation can be identified.
3, caseous pneumonia: This lesion is mostly produced in children with weak or low resistance, X-ray shows that in most of the lung segment and even a lobe lung shows dense consolidation, the contour is fuzzy, usually visible Translucent liquefied areas, even light-transparent voids, combined with medical history, tuberculin test, etc., are easily identified with bronchial pneumonia.
4, bronchial foreign body: there is a history of foreign body inhalation, or history of cough, clinical light, heavy, varying length of disease, prolonged course of the disease can have repeated fever, cough, lungs can smell and wet rales and Similar to pneumonia, sometimes auscultation and tracheal slap sounds can help diagnose, but the diagnosis is confirmed by fiber-optic patency.
5, bronchiolitis: very similar to acute pneumonia, but the disease is mainly wheezing, both lungs can hear a wide range of wheezing sounds and fine wet rales, severely ill children with hypoxia, X-ray only shows two The lungs have enhanced light transmission, the diaphragm is lowered, and the transient emphysema changes. A few sick children have a little spotted shadow.
