儿童重症支原体肺炎的临床特征和治疗探讨

Clinical characteristics and therapy of severe Mycoplasma pneumonia in children

目的早期识别重症支原体肺炎,并且把握治疗时机进行合理的治疗,是支原体肺炎研究领域的一个热点课题。该文探讨了重症支原体肺炎患儿的临床特征、治疗方案和转归规律。方法对79例支原体肺炎患儿(69例轻症,10例重症)的临床资料进行回顾性分析,并进行了随诊。结果与轻症组相比,重症支原体肺炎患儿入院前发热天数、总发热天数明显增多,外周血白细胞总数和C反应蛋白明显增高,血沉明显增快,IgM和IgE水平明显增高,而IgG和IgA水平无明显差异。10例重症支原体肺炎患儿中,急性期4例表现肺实变,4例表现肺实变合并中-大量胸腔积液,2例表现肺部病变进展迅速。9例重症患儿治疗除应用抗生素治疗外,加用糖皮质激素,疗效满意。恢复期有5例患儿肺部病变迁延不愈,需行纤维支气管镜灌洗。结论对于病情重、进展快、肺实变、中-大量胸腔积液、炎性指标明显升高、单用大环内酯类抗生素治疗反应不佳及病变迁延不愈的支原体肺炎应高度考虑重症支原体肺炎的可能性。一旦确诊,除抗生素治疗外,应积极早期应用糖皮质激素。对于病情稳定后仍有肺实变者,应尽早行纤维支气管灌洗。

Objective To study the clinical characteristics, therapeutic regimen and outcome of severe Mycoplasma pneumonia （MP） in children. Methods Clinical data of 79 children with MP, including 69 mild and 10 severe cases, were retrospectively analyzed. The l0 children with severe MP were followed-up. Results In severe MP cases, the fever duration prior to hospitalization and the total fever duration were more prolonged, peripheral blood leucocytes counts, C- reactive protein and erythrocyte sedimentation rate increased, and serum IgM and IgE levels increased as compared to mild MP cases. Of the 10 cases of severe MP, 4 manifested as pulmonary consolidation, 4 as pulmonary consolidation complicated by moderate to large pleural effusion and 2 as progressively worsening pulmonary radiographic findings. Nine severe MP cases were administered with glucocorticoid as well as antibiotics, and the therapeutic effect was satisfactory. In the convalescence stage, bronchofiberoscope lavages were used .in 5 severe cases because of persistent pulmonary consolidation. Conclusions Severe MP was characterized by rapid progression, pulmonary consolidation, moderate to severe pleural effusion, obviously increased inflammatory indexes, and poor therapeutic reaction to simple macrolide antibiotics. Besides antibiotics, glucocorticoid should be used for severe MP cases as soon as possible. For severe cases with persistent pulmonary consolidation, bronchofiberoscope lavages are recommended.