难治性支原体肺炎16例临床探讨

Clinical Study of Severe Mycoplasma Pneumonia in 16 Cases

目的探讨难治性支原体肺炎的临床特点和治疗方法。方法回顾性分析本院2008年8月至2010年1月收治的16例难治性支原体肺炎患者的临床资料。结果 16例患儿均以发热、咳嗽起病,呈稽留高热,12例CRP升高（22-68mg/L）,2例痰培养阳性,均为肺炎克雷伯菌;胸片示左中下肺野大片状阴影5例,右中下肺野大片状阴影4例,2例合并胸腔积液。1例合并肺不张。心电图异常3例,心肌酶谱CK-MB升高3例,肝功能异常2例,肌钙蛋白均正常。所有患儿均予大环内酯类抗生素治疗,5例联合应用美满霉素联合治疗取得良好疗效,2例痰培养阳性按药敏结果加用亚胺培南体温很快下降,5例加用甲基强的松龙治疗,热程缩短。结论对难治性支原体肺炎应根据病因及发病机制进行有效治疗。

Objective To explore the diagnosis and treatment of severe mycoplasma pneumonia（MPP）.Methods Clinical data of 16 cases of MPP from Aug,2008 to Jan,2010 were retrospectively analyzed.Results All the 16 cases started with fever and coughing,12 with arising of CRP（22～68mg/L）,2 were positive with Klebsiella of sputum cultivation,chest radiograph showed large shadow in left lower lung field,2 with pleural effusion,1 with Atelectasis.3 with ECG abnormalities,3 with myocardial enzymes CK-MB arising,2 with abnormal liver function,troponin were all normal.All the children were treated with macrolide antibiotics,5 were treated with combined therapy with perfect results,the 2 positive after sputum cultivation were treated with imipenem according to drug sensitivity and body temperature lowered rapidly,5 treated with methylprednisolone and the duration of fever was shortened apparently.Conclusion The effective treatments of severe MPP should be undertaken according to the etiology and pathogenesis.