Analysis Of Clinical Cases In Children With Severe Pneumonia Complicated With Congenital Heart Disease

Objective：By comparing the relative medical history，etiology，antimicrobial resistance， treatment and prognosis between children withsevere pneumonia complicated with Congenital Heart Disease （CHD）andage-matched children with pure severe pneumonia，this paper aims toexplore the characters of clinical cases and understand the necessity ofeffective and comprehensive treatment measures in Children with Severepneumonia complicated with CHD so as to reduce mortality and improvethe prognosis.Methods：Collecting the clinical datas of270Children with severepneumonia complicated with CHD，who were admitted in ChongqingChildren’S Hospital from in2012.01.01to2012.12.31，（defined as CHDgroup），to analyze the relative medical history， pathogens of theirnasopharyngeal secretions or sputum，drug-resistance，treatment and pr-ognosis.Moreover，636age-matched children with pure severe pneumoniawere studied as controls.Results：Firstly，of the270cases，160cases were male，110cases were female，269children exsisted with left-rightshunt congenital heartdisease（99.6％），250cases were babies（92.6％），37.04％of childrenwere onset in winter，35cases had suffered from pneumonia many times，43cases had different degree of malnutrition（15.93％），27cases withcongenital malformation outside the circulatory system(10.00%)，of which，22cases occurred in respiratory tract，5cases happened in digestive tract，5cases with Down’s syndrome，2cases with hand malformations，1caseswith hypothyroidism；88cases with heart failure，207cases with respiratoryfailure，and108cases with pulmonary arterial hypertension，among them14had mild PAH,47had moderate PAH and47had severe PAH.Comparedwith the controls， CHD group of earlier onset，more prone to repeatedpneumonia，and the higher incidence rates of malnutrition，congenitalmalformation outside the circulatory system and main complicationsincluding heart/respiratory failure and pulmonary arterial hypertension.Secondly，Of the270cases，totally220cases were checked out pathogens，which told no significant difference between CHD group and the controlone in the detection rates of pathogens(P＜0.05)，179cases were infectedwith bacteria，of which126ones were gram-negative bacterial，detectionrates of pathogens and gram-negative bacterial relatively higher than puresevere pneumonia group，the difference was statistically significant (P＜0.05)，95cases were infectted with virus，with respiratory syncytial virusbeing the most common pathogen，30cases were infectted with fungus， with Candida albicans were predominant，the infection rates of virus andfungus had no obvious difference between two groups(P＞0.05).Thirdly，Inthe drug sensitive test，merger of CHD group to produce extended spectrumbeta lactamase(ESBLs)positive detection rate was higher，the differencewas statistically significant (P＜0.05).Main gram-negative bacteria，Pneumonia klebsiella pneumonia subspecies e.coli bacterium andhaemophilus influenzae，were highly sensitive to imipenem，meropenem，levofloxacin and ciprofloxacin；main gram-positive bacteria Staphylococ-cus aureus and streptococcus pneumoniae， were highly sensitive tovancomycin and gentamicin.Especially，pneumonia klebsiella pneumoniasubspecies e.coli and s.pneumoniae were100%resistant to penicill-in.Fourthly，of the270cases，259cases of were given empirical antibioticuse immediately after entering the hospital (95.9%)，59cases using carbonalkene drugs (21.9%)，7cases with vancomycin (2.6%)，11cases using thesystemic antifungal drugs (4.1%); the cases of emergency operation were60， of which56cases got out of the hospital with great improvement(93.3%)，4cases died (6.7%)，however. Fifthly，Of270cases of severepneumonia with CHD group，the average length of hospital stay was（20.9±12.5）days，207cases with respiratory failure，88cases with heartfailure，205cases of the treatment is effective.Compared with the puresevere pneumonia group，children of severe pneumonia with CHD had alonger length of hospital stay, however，lower efficiency in treatment (P＜0.05).Conclusion：Because of the earlier onset， more prone to repeatedpneumonia，the higher incidence rates of malnutrition、congenital malform-ation outside the circulatory system and main complications includingheart/respiratory failure and pulmonary arterial hypertension， moresensitive to gram-negative bacterial，more ESBLs production，longerhospital stay and more prone to complications， compared with the controlgroup， Children with severe pneumonia complicated with CHD need totake comprehensive treatment measures， including improveing thecondition of patient’s cardio-pulmonary function，enhanceing immunity，effective using of antibiotics，and other treatments like this.But，if medicaltreatments were less effective or ineffective，surgical operation should bechoosed as early as possible.