儿童重症肺炎支原体肺炎60例临床分析

摘要

目的 探讨儿童重症肺炎支原体肺炎的临床特点、支气管镜及肾上腺皮质激素在其中的应用和预后.方法 2009年6月至2011年6月共诊断支原体肺炎256例,其中重症肺炎支原体肺炎共60例.对其临床特点、影像学及纤维支气管镜表现、肺外并发症和激素的治疗作用及预后进行综合分析.结果 在有效治疗前重症肺炎支原体肺炎主要表现为稽留热,重症组均以持续发热伴咳嗽为临床主诉,在获得有效治疗前平均发热天数为11.80±4.66天,比普通组5.12±1.83天明显延长(t=16.41,P<0.01).胸部CT提示肺内病变大多累及单侧肺,易合并中到大量胸腔积液及肺不张,以右肺上叶最多见.纤维支气管镜提示病变支气管开口黏膜肿胀充血,大量白色稠厚的纤维条索样分泌物阻塞开口.肺外损害的发生率达80.0%.重症肺炎支原体肺炎的炎症指标血清铁蛋白、C反应蛋白、血沉和乳酸脱氢酶明显升高.所有病例均早期加用肾上腺皮质激素治疗.所有重症肺炎支原体肺炎患者均预后良好.结论 重症肺炎支原体肺炎病情严重且较迁延.早期识别、早期积极加用激素治疗、早期进行支气管肺泡灌洗是重症肺炎支原体肺炎治疗的关键.大多患者预后良好,无肺部后遗症发生.%Objective To discuss the clinical features of severe mycoplasma pneumoniae pneumonia ( MPP ) in children, application of fiberbrochoscopy, glucocorticoid treatment and their prognosis in children. Methods From June 2009 to June 2011 256 cases were diagnosed with MPP and 60 cases of them were diagnosed were severe MPP. The data including clinical characteristics, fiberbrochoscopic and imaging features, extrapulmonary complications, glucocorticoid treatment and prognosis were collected and analyzed. Results All severe MPP were characterized by continued fever, and chief complaint of persistent fever complicated with cough before effective therapy. The mean fever duration was 11.8 ?. 66d before effective therapy, which was longer than 5. 12 ?. 83d of the non-severe MPP group ( t = 16.41 ,P <0. 01 ). Chest CT revealed that in most of the cases, lung lesions were only in unilateral pulmonary, easily accompanied with moderate to large amount pleural effusion and most of them on the superior lobe of right lung. The fiberbronchoscopy revealed obvious swelling of mucosa congestion in the opening of the bronchus and large amount of white and stiff secretion obstructing the opening of the bronchus. The incidence of extrapulmonary lesion was 80. 0% . Inflammatory markers such as level of serum ferritin, level of C-reactive protein, erythrocyte sedimentation rate and lactic dehydrogenase increased significantly in severe MPP. All cases were treated with glucocorticoid at early stage, and the prognosis of cases with severe MPP was good. Conclusion Cases with severe MPP have serious condition and have a long course of disease. Early diagnosis, early treatment with glucocorticoid and bronchoalveolar lav age ( BAL ) are the keys to a successful recovery from severe MPP. Most of cases have good prognosis without pulmonary sequelae.