儿童难治性肺炎支原体肺炎45例临床分析

Clinical analysis of children with refractory Mycoplasma pneumoniae pneumonia

目的：了解儿童难治性肺炎支原体肺炎（RMPP）的临床表现、实验室检查、影像学特点、治疗和预后。方法采用回顾性病例对照研究方法，分析45例 RMPP 和74例普通 MPP 患儿的临床资料，比较两组患儿一般资料、临床表现、胸部影像学、实验室检查以及治疗和预后。结果与普通 MPP 组比较，RMPP 组患儿年龄偏大[（6．14±3．35）岁]，发热时间[（9．49±5．28）d]、住院时间[（11．45±3．42）d]长，差异均有统计学意义（均 P ＜0．01）；单侧肺部受累[41（91．11％）]、肺部大片状实变影[35（77．78％）]、肺内并发症[21（46．67％）]和肺外并发症[24（51．33％）]发生率高，差异有统计学意义（P ＜0．05）；CRP、ESR、LDH、IgM均增高，差异有统计学意义（P ＜0．01）；37例（82％）RMPP 患儿需联合使用了头孢曲松钠，32例（71．7％） RMPP 需联合使用了糖皮质激素，6例 RMPP 患儿经纤维支气管镜肺泡灌洗介入治疗痊愈。仅1例 RMPP 患儿发生后遗症。结论年龄偏大儿童、持续高热、肺部大片实变影、肺内外并发症、CRP、ESR、LDH、IgM等增高是 RMPP 发病的临床相关因素，对大环内酯类药物治疗效果不好的患儿，可联合使用头孢类抗生素和／或激素治疗，纤维支气管镜肺泡灌洗介入治疗效果肯定。

Objective To study clinical manifestations,laboratory variables,imaging features and therapies of refractory Mycoplasma pneumoniae pneumonia （RMPP）.Methods The retrospective analysis of clinical data was conducted in 45 children with RMPP and 74 children with Mycoplasma pneumoniae pneumonia （MPP）admitted to department of pediatrics.The general data,clinical manifestations,laboratory variables,imaging features and therapies were compared between two groups.Results As compared to MPP,the age（6.14 ±3.35）y,febrile days（9.49 ± 5.28）d,the hospitalized days（11.45 ±3.42）d were significantly higher than that of MPP group （P 〈0.001）;RMPP had higher rations of unilateral pulmonary infiltration[41（91.11%）],large consolidation shadows[35（77.78%）], pulmonary[21（46.67%）]and extrapulmonary complications[24（51.33%）]（P 〈0.05）;CRP,ESR,LDH and IgM were increased,the difference was statistically significant （P 〈0.01）;Thirty -seven cases（82%）of RMPP had to add ceftriaxone sodium,thirty -two cases（71.7%）of RMPP had to add glucocorticoid,,Bronchofiberoscope lavages were used in six cases of RMPP.Only one case of RMPP occured sequela.Conclusion The older children,the per-sistent high fever,large consolidation shadows of pulmonary,pulmonary and extrapulmonary complications,high level of serum CRP,ESR,LDH and IgM are the clinical related factors of RMPP.The combination of cephalosporins and （or）glucocorticoid might consider for the cases who have no effect with macrolides.The effect is sure for RMPP with Bronchofiberoscope lavages.