6例难治性支原体肺炎的诊治体会

Clinical experience in therapy of refractory mycoplasma pneumoniae pneumonia in six children

目的了解难治性支原体肺炎的临床特点,提高诊断与治疗水平。方法对6例难治性支原体肺炎患儿的临床资料进行回顾性分析。结果 6例难治性支原体肺炎患儿中,急性期5例表现肺实变,3例表现肺实变合并大量胸腔积液,3例表现肺部病变进展迅速。6例难治性支原体肺炎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4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难治性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,improve diagnostic and therapeutic schedule of refractory Mycoplasma Pneumoniae pneumonia （RMPP） in children. Methods Clinical data of 6 children with RMPP, were retrospectively analyzed. Results Of the 6 eases of RMPP,5 manifested as pulmonary consolidation ,3 as puhnonary consolidation complicated by moderate to large pleural effusion and 3 as progressively worsening puhnonary radiographic findings. Six cases were administered with glucocorticoid as well as antibiotics. And the therapeutic effect was satisfactory. In the convalescence stage, bronchofiberoscope lavages were used ,in 4 severe eases because of persistent pulmonary consolidation. Conclusion RMPP was characterized by rapid progression, pulmonary consolidation, moderate tosevere pleural efusion, obviously increased inflammatory indexes, and poor therapeutic reaction to simple macrolide antibiotics. Besides antibiotics, gtucocorticoid should be used for RMPP cases as soon as possible. For severe cases with persistent pulmonary consolidation, bronchofiberoscope lavages are recommended.