Intensive Care Unit,the Children’s Hospital of Nanjing Medical University
目的 提高临床医生对合并肺部感染的脊髓性肌萎缩症(SMA)患儿的呼吸道管理及诊治水平。方法 回顾性分析2013年1月1日至2020年07月31日所收治的49例合并肺部感染的SMA患儿的临床资料。结果 49例中I型35例,II型14例,无III型患者。合并肺部感染的SMAI型患儿较II型患儿发病年龄更早,平均住院日更长(P<0.05)。SMAI型患儿发生心功能不全及呼吸衰竭的比率显著高于SMAII型患者(P＜0.05)。SMAII型咳嗽比率则显著高于SMAI型患者(P＜0.05)。SMAI型呼吸道病原检测以多重耐药菌及条件致病菌为主,SMAII型以支原体、肺炎链球菌感染为主。SMAI型患儿有创通气比率及碳青霉烯类抗生素使用率均显著高于SMAII型组 (P＜0.05)。结论 SMA患儿易合并肺部感染。积极促进气道分泌物排出、恰当的呼吸支持及合理抗感染是SMA合并肺部感染的治疗关键。
Objective To improve the clinicians" levels of respiratory management and treatment of children with spinal muscular atrophy (SMA) with pulmonary infection. Methods A retrospective analysis of the clinical data of 49 children with SMA complicated with pulmonary infection admitted from January 1, 2013 to July 31, 2020. Results Among the 49 cases, 35 cases were type I, 14 cases were type II, and there was no type III patient. Compared with type II, SMAI children with lung infection had an earlier age of onset, a longer average hospital stays (P<0.05). The rate of cardiac insufficiency and respiratory failure in children with SMAI type was significantly higher than that of patients with SMAII type (P<0.05). The cough rate of SMAII type was significantly higher than that of SMAI type patients (P<0.05). The detection of respiratory pathogens of the SMAI type is mainly multi-drug resistant bacteria and conditional pathogens, and the SMAII type is mainly infected by Mycoplasma and Streptococcus pneumoniae. The rate of invasive ventilation and the use of carbapenem antibiotics in children with SMAI werec significantly higher than those in the SMAII group (P＜0.05). Conclusion Children with SMA are prone to pulmonary infection. Actively promoting the discharge of airway secretions, appropriate respiratory support and reasonable anti-infection are the key to the treatment of SMA complicated with lung infection.