开始正文之前，明确几个先提条件，1. 本文讨论的是3个月大及以上的儿童；2.有慢性呼吸系统疾病、有免疫缺陷的儿童，不在本文讨论所列。3.院内感染的肺炎，也不在讨论之列。
简单的说，本文针对的是大于3月龄且平素健康的儿童，在医院外部，患有肺炎的应对措施，适合于绝大部分小朋友。
另外，本文依据的是2011年，美国感染学会和美国儿童感染疾病协会所发表的小儿肺炎应对策略。
我们节选几个比较常见，却又经常在国内被误导的几个问题，展现在此。临床儿科医生或小朋友家长，都可以参考，当然，也欢迎大家留言，参与讨论。
问题一：什么样的情况需要住院？
得了肺炎，或者疑似肺炎，有些情况，医生会建议小儿进行住院治疗，到底哪些情况，患儿是要求住院治疗的呢？原文是这样说的，一共四种情况，证据最充分的是第一条，其他证据不充分。
1. 中重度肺炎，主要由两个指标反应，即呼吸窘迫和低氧血症。呼吸窘迫，小儿常表现为呼吸速度过频（过频的标准，根据不同年龄的小孩不一样，比如1-5岁的小朋友，如果呼吸速率超过40次就为呼吸过频）、鼻翼煽动、精神异常、呼吸暂停或困难、呼吸时发出咕噜声等。低氧血症，以周围血氧饱和度持续低于90%为准。当然，儿科医生还会通过体格检查，获取更多关于呼吸窘迫的证据，所以有呼吸窘迫和低氧血症，不要犹豫，立即住院，强烈推荐，证据充分。
2. 3-6个月患儿，如果怀疑是细菌感染的社区获得性肺炎，住院可能会获益。
3. 如果患儿疑似或者确诊感染了毒性较强的细菌，比如社区相关的耐甲氧西林的金色葡萄球菌，应当考虑住院。所以细菌类型也很要紧。
4. 如果肺炎患儿在家照顾不方便，或者不能很好的在家完成治疗，复诊不方便的话，也建议住院。比如家里离医院比较远等原因。
Children and infants who have moderate to severe CAP, as defined by several factors, including respiratory distress and hypoxemia (sustained saturation of peripheral oxygen [SpO2],,90 % at sea level) should be hospitalized for management, including skilled pediatric nursing care. (strong recommendation; high-quality evidence)
Infants less than 3–6 months of age with suspected bacterial CAP are likely to benefit from hospitalization. (strong recommendation; low-quality evidence)
Children and infants with suspected or documented CAP caused by a pathogen with increased virulence, such as community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) should be hospitalized. (strong recommendation; lowquality evidence)
Children and infants for whom there is concern about careful observation at home or who are unable to comply with therapy or unable to be followed up should be hospitalized (strong recommendation; low-quality evidence)
问题二：疑似肺炎患儿，需要做哪些检查？
目前的现状是，如果怀疑肺炎，抽血做血常规和拍胸片基本是标配，真有必要吗，什么时候需要做血培养，还有流感病毒检测意义大吗？我们一条一条的来说。
血培养：对于门诊病人来说，血培养对于正常的患儿来说不是常规必须的检查项目，原文是这样说的。但是对于病情无好转，或者在使用抗生素后，病情加重或者恶化的患儿，还是应该做血培养的。住院肺炎患儿，中重度肺炎，特别是复杂性的肺炎病例，应当行血培养检查。
Blood cultures should not be routinely performed in nontoxic, fully immunized children with CAP managed in the outpatient setting. (strong recommendation; moderate-quality evidence)
Blood cultures should be obtained in children who fail to demonstrate clinical improvement and in those who have progressive symptoms or clinical deterioration after initiation of antibiotic therapy
Blood cultures should be obtained in children requiring hospitalization for presumed bacterial CAP that is moderate to severe, particularly those with complicated pneumonia. (strong recommendation; low-quality evidence)
血常规：所有门诊疑似肺炎患儿，没有必要做血常规检查。只有那些较重的病例，才考虑做血常规。请见原文：
Routine measurement of the complete blood cell count is not necessary in all children with suspected CAP managed in the outpatient setting, but in those with more serious disease it may provide useful information for clinical management in the context of the clinical examination and other laboratory and imaging studies.
流感病毒或者其他病毒检测：建议所有社区获得性肺炎患儿，都需进行流感病毒和其他呼吸病毒检测，因为如果病毒检测是阳性的话，可以减少其他化验和检查，同时也会避免抗生素的使用。原文如下：
Sensitive and specific tests for the rapid diagnosis of influenza virus and other respiratory viruses should be used in the evaluation of children with CAP. A positive influenza test may decrease both the need for additional diagnostic studies and antibiotic use, while guiding appropriate use of antiviral agents in both outpatient and inpatient settings. (strong recommendation; high-quality evidence)
胸片：1）门诊病例：如果能够在门诊就可以治疗的患儿，可以不用拍胸片，来确诊是不是肺炎。另外，如果门诊肺炎已经开始治疗了，但是效果不好，或是有低氧血症或者呼吸窘迫，那么就需要拍胸片。2）住院病例：所有住院病例，都应当行胸片检查。3）复查：如果肺炎恢复的很顺利，无需常规复查胸片。
Routine chest radiographs are not necessary for the confirmation of suspected CAP in patients well enough to be treated in the outpatient setting.
Chest radiographs (posteroanterior and lateral) should be obtained in all patients hospitalized for management of CAP.
Repeated chest radiographs are not routinely required in children who recover uneventfully from an episode of CAP.u
参考文献：
John S. Bradley,1,a Carrie L. Byington,et al,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 AmericaClinical Infectious Diseases 2011;53(7):e25–e76
本文来自投稿，不代表本人立场，如若转载，请注明出处：http://www.sosokankan.com/article/1765542.html