Course, Complications and Prognosis of Open Pulmonary Tuberculosis in Children.
Course, Complications and Prognosis of Open Pulmonary Tuberculosis in Children.
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DOI：
10.1016/s0041-3879(34)80211-5
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发表时间：
1935-01-01
期刊：
影响因子：
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通讯作者：
Cochrane, E.
中科院分区：
文献类型：
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作者：
Cochrane, E.
作者在本文中收集和分析了在1922年至1931年的十年间，从布伦特伍德海伍德的伦敦郡议会医院出院的710名开放性肺结核儿童的病例记录。该系列包括470名女孩和240名男孩，年龄在3至15岁之间，除27名粪便呈阳性外，所有人的痰中都有结核菌。病例分类如下：第一组：慢性病程。这是最大的群体，包括164名女孩和94名男孩，他们从入院到死亡之日的生存期大约为2年，在极少数情况下为10年。给出了一个小的亚组病例，包括28名女孩和13名男孩，他们的生存期虽然平均比主要组短，但不少于两年，他们的疾病是慢性的，有食欲，但脉搏快。另一个亚组表现出慢性病程，尽管有发热，但体重增加。它由20个女孩和7个男孩组成。第二组由急性病程（1至9个月死亡）后发病的107名女孩和31名男孩组成。在绝大多数病例中，发病迅速，典型表现为急性肺结核，明显程度的毒血症（发热和脉搏加快）和死后结核性支气管肺炎的体征。在一个由14名女孩和19名男孩组成的亚组中，耐药性更明显，生存时间更长（9至18个月）。第三组有完全或部分康复的81名女孩和50名男孩的记录。家族史、发病方式、疾病程度或一般情况均不能作为预后的指导。第四组最初有所改善，随后迅速下降，包括24名女孩和7名男孩。值得注意的是，虽然入院后体温恢复正常，体重增加，但从未观察到相应的脉搏率下降。V组有32名女生和19名男生不能分类。一项对儿童疾病进程的三个重要标志——体温、脉搏和体重的研究表明，后两个指标更准确地反映了病情的真实状态。虽然体温和脉搏正常，但体重在几个月内保持不变的孩子，以及体重正在减轻的孩子，都没有取得任何进展。在夏季的几个月里可能会遇到一个例外。在好天气里，人们有机会增加各种形式的活动，再加上炎热导致的食欲不振，有时会导致体重暂时停止增长。然而，通常可以认为，正在克服感染的儿童通过再次获得童年的正常功能，即成长，预示着其即将回归正常。最常见的并发症是咯血、结核性喉炎、自发性气胸、胸腔积液、结核性腹膜炎、脑膜炎、骨关节结核和瘘管（宫颈腺炎仅发生三次）。下面是根据1922年至1929年期间男女人数计算的最终结果表。（所有结果均以百分比表示）。[img 1 t11570.tif。
The case records of 710 children, with open pulmonary tuberculosis who were discharged from the London County Council Hospital at High Wood, Brentwood, during a ten-year period 1922-31, are collected and analysed by the author in this article. The series comprises 470 girls and 240 boys, ranging in age from 3 to 15 and all of them having tubercle bacilli in the sputum, except 27 whose faeces were positive. The cases are classified asfollows: Group I-Cases following a chronic course. This is the largest group and comprises 164 girls and 94 boys, the period of their survival from the time of admission to hospital to the date of their deaths ranging from approximately 2 to, in rare cases, 10 years. A small sub-group of cases is given, consisting of 28 girls and 13 boys in whom the period of survival, while shorter than the main group on the average, was not less than two years and in whom the disease followed a chronic course with apyrexia but rapid pulse. Another subgroup exhibited a chronic course with gain of weight despite pyrexia. It consists of 20 girls and 7 boys. Group II is composed of 107 girls and 31 boys with disease following an acute course (fatal in 1 to 9 months). In the great majority of cases the onset was rapid with typical appearances of acute phthisis, marked degree of toxaemia (pyrexia and increased pulse rate) and postmortem signs of tuberculous bronchopneumonia. A sub-group of 14 girls and 19 boys is given in whom resistance was more marked and survival longer (9 to 18 months). Group III contains records of 81 girls and 50 boys with complete or partial recovery. No points stand out in family history, mode of onset, extent of disease or general condition as a guide of prognosis. Group IV shows initial improvement followed by rapid decline, and comprises 24 girls and 7 boys. This group is noteworthy for the fact that though temperature became normal and weight increased after admission, a corresponding fall in pulse-rate was never observed. Group V contains 32 girls and 19 boys not capable of classification. A study of the three great signposts of progress in the course of the malady in children, temperature, pulse, and weight, revealed that the two latter indicate more accurately the true state of affairs. The child whose weight is stationary over a period of months despite a normal temperature and pulse, as well as the child who is losing weight, is making no progress. An exception to this rule may be encountered during the summer months. The opportunities afforded in good weather for increased forms of activity, coupled with a loss of appetite due to the heat, sometimes result in a temporary cessation of gain in weight. As a rule, however, it may be maintained that the child who is overcoming infection heralds its approaching return to normality by once again attaining the normal function of childhood, namely, growth. The commonest complications in the series are, in order of frequency, haemoptysis, tuberculous laryngitis, spontaneous pneumothorax, pleural effusion, tuberculous peritonitis, meningitis, tuberculosis of bones and joints, and fistula in ano (cervical adenitis only occurs three times). A table of end results based on figures for both sexes for the period 1922-1929 is given below. (All results are given as percentages). [img 1T11570.tif.