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儿科急诊

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小儿肺炎(Pediatric Pneumonia)
原作者: Mimi Lu,肖锋译 发布日期:2013-04-05

Title: Pediatric Pneumonia
题目:小儿肺炎
Author 作者: Mimi Lu

You have diagnosed an infant or child with pneumonia.  How do you decide if they need admission?
你刚刚诊断一个婴儿或儿童患有肺炎。如何决定患儿需不需要住院治疗?
The Pediatric Infectious Disease Society and the British Thoracic Society each have guidelines from 2011 to help with this decision.
美国儿科感染病学会和英国胸科学会在2011年发表的指南将有助于你的决定。
 The Pediatric Infectious Disease Society recommend inpatient therapy for the following
美国儿科感染病学会住院治疗标准

1) oxygen saturation <90% 氧饱和度低于90%
2) infants less than 3-6 months of age with bacterial infection being the likely etiology
3-6个月婴儿高度怀疑有细菌感染
3) pneumonia from suspected or documented virulent pathogen such as CA-MRSA
由可疑或证实的恶性病原菌(如院外获得的MRSA)导致的肺炎
4) children in whom home care is questionable, outpatient follow-up is not available or who cannot comply with outpatient therapy
不能落实可靠的家庭治疗,不能随诊,不能遵守门诊治疗方案
 
The British Thoracic Society identify risk factors likely to require hospitalization:
英国胸科学会明确了需要住院的几个危险因素:
1) oxygen saturation <92% 氧饱和度低于92%
2) respiratory rate > 70 breaths/min (>50 breaths/min in older children)
呼吸频率每分钟超过70次(大一点的小孩超过50次)
3) significant tachycardia for level of fever 与发病程度不相符的心动过速
4) prolonged capillary refill time > 2 seconds 毛细血管充盈时间超过2秒钟
5) breathing difficulty 呼吸困难
6) intermittent apnea 间歇性呼吸停止
7) not feeding or signs of dehydration 不能口入或有脱水征
8) chronic medical conditions/comorbidities 慢性疾病或合并症
 
References 参考文献:
"The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America"
http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/2011%20CAP%20in%20Children.pdf

"Guidelines for the management of community acquired pneumonia in children: update 2011" BTS
http://www.brit-thoracic.org.uk/Portals/0/Guidelines/Pneumonia/CAP%20children%20October%202011.pdf