68例小儿难治性肺炎支原体肺炎临床分析

Clinical report on 68 cases of refractory mycoplasma pneumoniae pneumonia （ RMPP）

目的 通过分析68例儿童难治性肺炎支原体肺炎（RMPP）病例特点,总结RMPP早期识别和综合治疗的方法.方法 2008年1月至2010年12月首都医科大学附属北京儿童医院国际部收治的资料完整的难治性肺炎支原体肺炎（RMPP）病例68例.搜集总结患者支原体抗体、C-反应蛋白、白细胞、血沉、胸片等多项实验室和影像学证据.结果 100%RMPP出现高热并逐渐出现肺部体征,部分患者出现心电图异常、肝功受损、皮疹等肺外表现.诊断RMPP后应用大环内酯类治疗2-4疗程,加用甲基泼尼松龙.重症或激素无效的给予免疫球蛋白治疗.合并细菌感染的联合应用敏感抗生素.纤维支气管镜在RMPP治疗中有一定作用.结论 早期识别对RMPP的诊断尤为重要,采取综合措施才能保证RMPP治疗效果.

Objective To summarize the early diagnose and treatment approaches of Refractory Mycoplasma Pneumoniae Pneumonia （ RMPP）. Methods Medical documents of 68 cases of RMPP were reviewed. Lab and radiology evident such as CBC, CRP, MP-IgM, X-ray, etc. were collected. Results 100% RMPP patients suffered from high fever. Positive sign of lung became clear with the development of the disease. Complications as impairment of liver function, cardiac function and rush developed in few patients. 2-4 rounds treatment of macrolides and Methyllprednisolone were necessary for RMPP while antibiotic may be considered when there were evidence of bacteria infection. Immunoglobulin was recommended to the patients when macrolides and steroid seemed ineffective. Bronchofibroscope played an active role regarding the diagnosis and treatment of RMPP. Conclusion Early diagnosis is crucial in RMPP. Combination of multitreatment approaches is the key to cure RMPP.