婴幼儿重症肺炎支原体肺炎22例临床分析

Clinical analysis of 22 severe infant cases of mycoplasma pneumonia

目的分析婴幼儿重症肺炎支原体(MP)肺炎的发病特点,提高其诊断和治疗水平。方法对2004年1月至2007年12月本院收治的22例婴幼儿重症MP肺炎的临床特征及诊治情况进行回顾性分析。结果婴幼儿重症MP肺炎中有18例(81.8%)的患儿起病急,以剧烈咳嗽、气喘起病,并很快出现发热和呼吸困难;肺外并发症多见,20例(90.9%)均有不同程度的肺外症状,其中有13例(59.1%)同时有2个或2个以上肺外器官系统受累;肺部病变严重,6例并发大叶肺实变,4例并发肺不张;5例单用大环内酯类抗感染疗效不佳;20例完全康复,2例仍遗留肺不张。结论肺炎支原体可引起重症肺炎,对于临床上有上述表现的重症肺炎,应考虑到重症MP肺炎的可能性,除使用阿奇霉素外,可应用糖皮质激素和大剂量丙种球蛋白治疗;对疗效不佳病例,可并用利福平,注意防治混合感染。

Objective To study clinical characteristics and improve diagnosis and treatment of the severe infant＇s mycoplasma pneumonia （MP）. Methods The chief clinical manifestation and therapy of 22 hospitalized severe infant＇s MP were analyzed retrospectively from January 2004 to December 2007. Results The onset of the illness was more acute. It was started with severe cough and gasp,followed with fever and dyspnoea in 18 cases （81.8%）. The extrapulmonary complication was not uncommon. There were 20 cases （90.9%） got extrapulmonary symptoms in different degree,even 13 cases （59.1%） simultaneously got 2 or above extrapulmonary organs injuried. Another characteristic of the illness was severd pulmonary pathological changes including lobar pneumonia （6 cases） and pulmonary atelectasis （4 cases）. The solo use of Macrolides showed no good response in 5 cases. Most of the patients （20 cases） completely rehabilitated themselves but 2 left pulmonary atelectasis. Conclusion The mycoplasma pneumonia causes severe pulmonary symptoms in infant patients,these symptoms set out signals for the possibility of MP in clinical consideration. Besides Azithromycin,the glucocorticoid and large dose of gamma globulin are useful for the treatment. To those respond insensively to above drugs,Rifamycin could be alternated but combined infection be prevented.