重症支原体肺炎并发症的诊治

Diagnosis and treatment of complications of severe mycoplasma pneumonia

重症肺炎支原体肺炎(MPP)逐年增多,其临床表现复杂多样,常伴肺内、肺外多系统损害。肺内并发症以不同程度胸腔积液、肺不张最为常见,此外还有闭塞性细支气管炎、坏死性肺炎/肺脓肿、支气管扩张、气胸、肺栓塞等表现。国内报道,肺外并发症以心血管、消化系统及血液系统症状最为常见,另外神经系统、泌尿系统、肌肉关节及皮肤也常累及。国外文献报道以神经系统损害最常见。部分患儿可同时出现2种或2种以上的肺外并发症,甚至少数以肺外并发症为首发症状,易造成误诊、漏诊及遗留远期后遗症。治疗上及时应用大环内酯类药物,早期使用糖皮质激素和(或)静脉用丙种球蛋白(IVIG),控制合并感染与肺内外并发症,可显著改善预后。

Children with severe mycoplasma pneumonia are increasing in recent years. The clinical manifestations are complex and varied. Damages in every system can be involved in extrapulmonary complications of MPP. Pleural effusion and atelectasis are the most common pulmonary complications,and the others are bronchiolitis,necrotizing pneumonia/lung abscess,bronchiectasis,pneumothorax and pulmonary embolism.It is reported in China that the most common system involved in extrapulmonary complications of MPP are cardiovascular system,digestive system and hematological system. The other systems involved are nerve system,urinary system,muscle joints and skin. It is reported in foreign literatures that the most common damage of MMP is neurological system. Some patients have two or more organ damages. And sometimes symptoms of extrapulmonary complications can be the first symptom of the patients,which easily causes misdiagnosis.Prognosis can be significantly improved by the application of macrolide medicine,glucocorticoid and（or）prompt IVIG.