分泌物堵塞呼吸道的儿童肺炎支原体肺炎临床特征

Clinical analysis of children’s mycoplasma pneumoniae pneumonia blocked with glutinosity secretions from bronchioles

目的 总结分泌物堵塞呼吸道的肺炎支原体肺炎（MPP）患儿的临床特征.方法 回顾性分析51例MPP患儿临床资料,根据纤维支气管镜下情况,分为堵塞组和畅通组,对比患儿的临床表现、实验室检查、影像学特征.结果 堵塞组20例,其中男7例,女13例;畅通组31例,其中男16例,女15例.与畅通组相比,堵塞组患儿总热程更长,差异有统计学意义[（15.2±7.6）d比（8.5±3.9）d,t=2.801,P＜0.05].热程≥10 d者,畅通组7例（占22.6％）,堵塞组16例（占80.0％）.体温＞40.0℃者,畅通组5例（占16.0％）,堵塞组14例（占70.0％）.堵塞组患儿C反应蛋白水平明显高于畅通组[89（12- 204） mg/L比19（1- 78） mg/L,Z=-4.229,P＜0.05],乳酸脱氢酶水平亦明显高于畅通组[（465.5±166.7） U/L比（296.5 ±117.0） U/L,t=-4.255,P＜0.05].2组白细胞计数、中性粒细胞比较差异均无统计学意义（P均＞0.05）.堵塞组患儿影像学表现为整叶以上均一致密高实变影,发生肺坏死比例为10.0％;堵塞组合并胸腔积液14例（占70.0％）,畅通组合并胸腔积液7例（占22.6％）.结论 对于多数MPP患儿,纤维支气管镜可作为择期诊治手段,但当MPP患者出现持续高热≥10d,伴咳嗽少、精神差,肺CT提示整叶以上均一致密实变影且合并胸腔积液,C反应蛋白及乳酸脱氢酶明显增高,应注意分泌物堵塞呼吸道的可能;早期行纤维支气管镜肺泡灌洗术可能缩短病程,减少并发症.

Objective To analyze the clinical manifestations of mycoplasma pneumoniae pneumonia blocked with glutinosity secretions from the bronchioles.Methods Retrospective analysis was performed on the clinical data of 51 children.The patients were divided into a blocked group and an unblocked group according the performance of flexible bronchoscopy.The clinical manifestations, laboratory examination, radiological features and bronchofibroscopic findings from the children were compared.Results The blocked group had 20 children （7 boys and 13 girls）;the unblocked group had 31 children （16 boys and 15 girls）.Compared with the unblocked group,the blocked group had longer fever duration [（15.2 ± 7.6） d vs （8.5 ± 3.9） d, t =2.801, P 〈 0.05].Patients＆#39; fever duration more than 10 days included 7 cases（22.6%） in the unblocked group,and 16 cases（80.0%） in the blocked group;patients with fever higher than 40.0 ℃ included 5 cases（16.0%） in the unblocked group and 14 cases（70.0%） in the blocked group.The C-reactive protein（CRP） and lactic dehydrogenase（LDH） levels in the blocked group were significantly higher than those in the unblocked group [CRP ： （89 （12 - 204） mg/L vs 19 （1 - 78） rag/L, Z =-4.229, P 〈 0.05;LDH ： （465.5 ± 166.7） U/L vs （296.5 ± 117.0） U/L, t =-4.255, P 〈 0.05].However, no significant difference was found in levels of the white blood cell count and the percentage of neutrophils count in 2 groups （all P 〉 0.05）.It was seen that in the blocked group that chest CT scan indicated high density consolidation in no less than a whole pulmonary lobe and pulmonary necrosis more frequently seen in the blocked group （10.0%）;there were 7 cases（22.6%）with pleural effusion in the unblocked group, and 14 cases（70.0%）with pleural effusion in the blocked group.Conclusions Flexible bronchoscopy can be used optionally in most of the children with mycoplasma pneumoniae pneumonia, and if there is a lasting high fever for more than 10 days, with slight cough and lassitude, chest CT scan indicating high density consolidation involved a whole pulmonary lobe and pleural effusion, or CRP and LDH significantly higher, there is possibility that bronchiole secretions might block the respiratory tract, and in such a case earlier bronchofibroscopic bronchoclysis could be done to shorten the course of disease and reduce complications as well.