儿童支原体肺炎临床、影像学及纤维支气管镜诊治研究

Clinical characteristics,X-ray features and bronchoscopic diagnosis and treatment of mycoplasma pneumonia in children

目的探讨儿童支原体肺炎的临床、影像、肺功能及纤维支气管镜改变,研究纤维支气管镜介入治疗支原体肺炎的疗效。方法回顾性分析207例支原体肺炎患儿临床资料,并对其中135例胸部X线片表现为肺部大片浸润或肺不张的急性支原体肺炎患儿进行随访研究,其中61例给予纤维支气管镜检查、病变局部介入治疗和大环内酯类抗生素内科治疗(治疗组),74例仅给予大环内酯类抗生素内科治疗(对照组),随访比较治疗组、对照组肺部病变吸收情况。结果207例支原体肺炎患儿临床主要表现为咳嗽207例(100%),发热185例(89.4%),气促49例(23.7%),喘息29例(14.0%),胸痛28例(13.5%),皮疹13例(6.3%);肺部有阳性体征73例(35.3%),外周血白细胞正常93例(44.9%),轻度增高97例(46.9%),血清CRP多有升高;支原体肺炎胸片最常见表现为肺实质阴影(57%,118/207),其中大片浸润阴影98例(47.3%);肺不张37例(17.9%)。139例肺通气功能(75.1%,139/185)有不同程度异常,主要表现为小气道功能改变;纤维支气管镜下均可见黏膜粗糙、肿胀、分泌物附着,管腔分泌物多数呈半透明或灰白黏稠状,部分形成黏液栓阻塞细支气管。其中段支气管通气不畅46例(75.4%),管腔开口炎性狭窄28例(45.9%),管腔开口闭塞13例(21.3%);血管走行粗重33例(54.1%);黏膜纵行皱褶20例(32.8%),黏膜花斑样改变11例(18.0%),黏膜腺体小结样突起6例(9.8%),黏膜糜烂3例(4.9%)。治疗2周后肺部大片浸润吸收率治疗组为100%,对照组为88.7%,差异有统计学意义(P=0.02),肺不张复张率治疗组为87.5%,对照组为52.4%,差异具有统计学意义(P=0.024),治疗组肺部大片浸润吸收时间、肺不张复张时间较对照组明显提前。结论联合纤维支气管镜介入治疗有利于促进肺部病变吸收从而缩短病程。

Objective To investigate the clinical characteristics,chest radiographic features,lung function and bronchoscopic changes in children with mycoplasma pneumonia,and to explore the interventional therapeutic effects of mycoplasma pneumonia by bronchoscopy.Methods Clinical data of 207 children（age 7.1±2.5） with mycoplasma pneumonia who were admitted in our center from Jan.2007 to Jan.2009 were retrospectively analyzed.Among them,135 whose X-ray film presented subtotal lung infiltration or atelectasis were followed up.Sixty-one patients of them were given bronchoscopy examination and local interventional therapy and macrolide antibiotic treatment（treatment group）,and 74 of them were only given macrolide antibiotic treatment（control group）.The Absorption of lesions between the treatment and control groups were compared.Results The common clinical manifestations were cough（100%,207/207）,fever（89.4%,185/207）,tachypnea（23.7%,49/207）,wheeze（14.0%,29/207）,chest pain（13.5%,28/207）,and rash（6.3%,13/207）.Seventy-three cases had positive physical signs（35.3%）,93 cases had peripheral leukocytes normal（44.9%）,while 97 had mild increased（46.9%）,and most had increased serum concentration of CRP.The most common signs in X-ray films were the shadows of lung parenchyma（57%,118/207）.Ninety-eight cases had large segment shadows（47.3%）,and 37 cases had atelectasis（17.9%）.One hundred and thirty-nine cases had ventilation disorders（75.1%）,presenting the functional changes of small airway.Under flexible bronchoscope,46 patients had section bronchial ventilation stagnation（75.4%）,28 patients had tube debouchement inflammatory stenosis（45.9%）,13 patients had tube occlusion（21.3%）,33 patients showed blood vessel becoming gross（54.1%）,20 patients had mucosal longitudinal folds（32.8%）,11 patients had mucosa piebald shape（18%）,6 patients had mucosa crypts nodule（9.8%）,and 3 patients had mucosa anabrosis（4.9%）.After 2 weeks＇ treatment,the rate of pulmonary infiltration in the treatment group was significantly higher than in the control group（100% vs 88.7%,P=0.02）.The rate of atelectasis disappearance in the treatment group was significantly higher than in the control group（87.5% vs 52.4%,P=0.024）.Conclusion It is beneficial to shorten course of disease by applying flexible bronchoscopy to treat patients with mycoplasma pneumonia.