中国麻风皮肤病杂志 ›› 2025, Vol. 41 ›› Issue (9): 670-673.doi: 10.12144/zgmfskin202509670

• 临床研究 • 上一篇    下一篇

晚期新生儿水痘合并重症肺炎二例并文献复习

张德蓝,丁玲,高一,郑永利   

  1. 成都市公共卫生临床医疗中心,四川成都,610000
  • 出版日期:2025-09-15 发布日期:2025-09-08

Varicella complicated with severe pneumonia in late neonates: two cases report and literature review

ZHANG Delan, DING Ling, GAO Yi, ZHENG Yongli   

  1. Public Health Clinical Center of Chengdu, Chengdu 610000, China
  • Online:2025-09-15 Published:2025-09-08

摘要: 本文报道我院收治的2例晚期新生儿后天感染水痘合并重症肺炎的临床病例,并进行文献复习。2例患儿均以皮疹为首发症状,后渐出现发热、咳嗽、气促、氧饱和度降低等表现;经胸部CT检查明确有肺实变,经过积极治疗后均临床治愈。共检索到新生儿水痘并发肺炎相关文献16篇,包含病例79例,临床表现主要为水痘皮疹基础上伴发热、咳嗽、气促、吐沫、拒奶、精神差,重症病例有低氧血症、呼吸衰竭甚至肺出血。79例患者中17例明确描述影像学表现,其中肺部影像提示肺透光度降低、白肺、(大)片状致密影、絮状模糊影3例,均死亡;肺实变、肺不张等改变1例,主要为斑片影、条索影13例,均临床治愈。晚期新生儿水痘若及时诊断和治疗,预后较好,但仍有出现严重并发症可能。临床诊疗过程中应重视氧饱和度监测,及时完善病原学检查,早发现、早治疗,减少并发症,改善预后。

关键词: 新生儿水痘, 重症肺炎, 肺实变, 阿昔洛韦

Abstract: This paper presents 2 neonates with acquired varicella complicated by severe pneumonia admitted to our hospital, and conducts a literature review. Both cases presented with skin rashes as the initial symptom, followed by the gradual onset of fever, cough, shortness of breath, decreased oxygen saturation, and other manifestations. Chest CT examinations confirmed pulmonary consolidation, and both achieved clinical cure after active treatment. A total of 16 relevant literatures on neonatal varicella complicated by pneumonia were retrieved, involving 79 cases. The clinical manifestations mainly included fever, cough, shortness of breath, frothing, milk refusal, and poor mental state on the basis of varicella rashes and severe cases had hypoxemia, respiratory failure, and even pulmonary hemorrhage. Among the 79 patients, were described imaging findings in 17 cases, including 3 cases with lung imaging showing decreased lung transparency, white lung, (large) patchy dense shadows, and flocculent blurred shadows, all of whom died; 1 case with changes such as pulmonary consolidation and atelectasis, and 13 cases mainly with patchy shadows and streak shadows, all of whom achieved clinical cure. Late neonatal varicella has a good prognosis if diagnosed and treated in a timely manner, but there is still the possibility of severe complications. During clinical diagnosis and treatment, attention should be paid to oxygen saturation monitoring, and etiological examinations should be improved in a timely manner to achieve early detection and early treatment, reduce complications, and improve prognosis.

Key words: neonatal varicella, severe pneumonia, pulmonary consolidation, acyclovir