儿童难治性支原体肺炎诊疗进展

Progress in diagnosis and treatment of refractory mycoplasma pneumonia in children

儿童难治性支原体肺炎(refractory mycoplasma pneumonia,RMPP)是支原体肺炎经大环内酯类药物治疗>7d症状加重的一类疾病,多见于学龄期儿童,常因治疗效果不佳、病情发展迅速、短时间内出现严重并发症导致患儿发生生命危险。本研究旨在对儿童难治性支原体肺炎的诊治概况进行总结。通过CNKI、万方、维普、CBM和PubMed等数据库检索文献,日期截至2019-12-31,纳入儿童难治性支原体肺炎相关的诊断、治疗、流行病学调查、并发症、病理报告等类型的文章,排除其他类型支原体肺炎。最终纳入38篇文献,对儿童难治性支原体肺炎的发病因素、诊断方法、治疗方式及并发症的预防进行系统总结归纳,以期为广大医务工作者提供参考,进一步完善儿童难治性支原体肺炎的诊疗体系。在大环内酯类抗生素耐药、免疫损伤及混合性感染等因素影响下,RMPP具有常规大环内酯类抗生素治疗效果不佳、病情进展快等特点,需早期通过临床表现、实验室和影像学检查进行诊断,予以早期、足周期的治疗,根据患儿免疫强度及支原体感染RMPP耐药情况及时调整治疗方案,抑制过强的免疫反应,对大环内酯类完全无效的RMPP患儿,可考虑更换抗肺炎支原体药物种类如喹诺酮、四环素等。并及时预防微血栓、黏液栓等并发症。

Refractory mycoplasma pneumonia(RMPP)in children is a type of disease that exacerbates mycoplasma pneumoniae for more than 7 days after treatment with macrolides.It is more common in children of school age.It is often caused by poor treatment and rapid disease progression.In a short period of time,serious complications can cause lifethreatening children.The purpose of this study is to summarize the diagnosis and treatment of refractory mycoplasma pneumonia in children.Searched from databases such as CNKI,Wanfang,VIP,CBM and PubMed,as of 2019-12-31,it included articles related to the diagnosis,treatment,epidemiological investigation,complications,and pathology report of children with refractory mycoplasma pneumonia,and exclude other types of mycoplasma pneumonia.Finally,38 articles were included to systematically summarize the incidence factors,diagnostic methods,treatment methods and prevention of complications of refractory mycoplasmal pneumonia in children,in order to provide a reference for the majority of medical workers and further improve the diagnosis and treatment system.Under the influence of macrolide antibiotic resistance,immune damage and mixed infection,RMPP has the characteristics of poor treatment and rapid progress of conventional macrolide antibiotics.It is necessary to make early diagnosis through clinical manifestations,laboratory and imaging examination,and give early and sufficient treatment.According to the immune intensity of children and the resistance of mycoplasma infection to RMPP,the treatment plan should be adjusted in time to inhibit the over strong immune response.For children with RMPP who are completely ineffective in macrolides,the types of anti MP drugs such as quinolones and tetracyclines can be considered to be replaced.The complications such as micro thrombus and mucus thrombus are prevented in time.