中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2015年
12期
1801-1805
,共5页
肺炎,支原体%儿童
肺炎,支原體%兒童
폐염,지원체%인동
Pneumoniae mycoplasma%Child
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。
目的：瞭解兒童難治性肺炎支原體肺炎（RMPP）的臨床錶現、實驗室檢查、影像學特點、治療和預後。方法採用迴顧性病例對照研究方法，分析45例 RMPP 和74例普通 MPP 患兒的臨床資料，比較兩組患兒一般資料、臨床錶現、胸部影像學、實驗室檢查以及治療和預後。結果與普通 MPP 組比較，RMPP 組患兒年齡偏大[（6．14±3．35）歲]，髮熱時間[（9．49±5．28）d]、住院時間[（11．45±3．42）d]長，差異均有統計學意義（均 P ＜0．01）；單側肺部受纍[41（91．11％）]、肺部大片狀實變影[35（77．78％）]、肺內併髮癥[21（46．67％）]和肺外併髮癥[24（51．33％）]髮生率高，差異有統計學意義（P ＜0．05）；CRP、ESR、LDH、IgM均增高，差異有統計學意義（P ＜0．01）；37例（82％）RMPP 患兒需聯閤使用瞭頭孢麯鬆鈉，32例（71．7％） RMPP 需聯閤使用瞭糖皮質激素，6例 RMPP 患兒經纖維支氣管鏡肺泡灌洗介入治療痊愈。僅1例 RMPP 患兒髮生後遺癥。結論年齡偏大兒童、持續高熱、肺部大片實變影、肺內外併髮癥、CRP、ESR、LDH、IgM等增高是 RMPP 髮病的臨床相關因素，對大環內酯類藥物治療效果不好的患兒，可聯閤使用頭孢類抗生素和／或激素治療，纖維支氣管鏡肺泡灌洗介入治療效果肯定。
목적：료해인동난치성폐염지원체폐염（RMPP）적림상표현、실험실검사、영상학특점、치료화예후。방법채용회고성병례대조연구방법，분석45례 RMPP 화74례보통 MPP 환인적림상자료，비교량조환인일반자료、림상표현、흉부영상학、실험실검사이급치료화예후。결과여보통 MPP 조비교，RMPP 조환인년령편대[（6．14±3．35）세]，발열시간[（9．49±5．28）d]、주원시간[（11．45±3．42）d]장，차이균유통계학의의（균 P ＜0．01）；단측폐부수루[41（91．11％）]、폐부대편상실변영[35（77．78％）]、폐내병발증[21（46．67％）]화폐외병발증[24（51．33％）]발생솔고，차이유통계학의의（P ＜0．05）；CRP、ESR、LDH、IgM균증고，차이유통계학의의（P ＜0．01）；37례（82％）RMPP 환인수연합사용료두포곡송납，32례（71．7％） RMPP 수연합사용료당피질격소，6례 RMPP 환인경섬유지기관경폐포관세개입치료전유。부1례 RMPP 환인발생후유증。결론년령편대인동、지속고열、폐부대편실변영、폐내외병발증、CRP、ESR、LDH、IgM등증고시 RMPP 발병적림상상관인소，대대배내지류약물치료효과불호적환인，가연합사용두포류항생소화／혹격소치료，섬유지기관경폐포관세개입치료효과긍정。
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.
