110例儿童重症肺炎支原体肺炎临床特点分析

摘要

Objective To study the clinical characteristics of severe Mycoplasma pneumoniae pneumonia (MPP)in children,and to provide a basis for diagnosis and treatment.Methods Retrospective analysis was performed on the epidemiological and clinical data of the children who were hospitalized due to severe MPP from January 2014 to December 2015 in the hospital.Results Among the 110 children who were hospitalized due to severe MPP,43 cases were between 0 and 1 years old,39 cases >1-3 years old,18 cases >3-5 years old and 10 cases >5 years old.The incidence of MPP varied with the seasons and was significantly highest in summer.With the growing of ages,the proportion of children with cough,with rale all decreased,the proportion of pulmonary complications(including lung abscess,hydrothorax,emphysema and pneumothorax)and pathological change of right lung both increased (P 1~3岁组39例,>3~5岁组18例,>5岁组10例;不同季节重症MPP感染率不同,夏季发病最多;各年龄组咳嗽、肺部啰音比例依次减低(P<0.05);各年龄组白细胞计数差异有统计学意义(P<0.05);C反应蛋白(CRP)、乳酸脱氢酶差异无统计学意义;随着年龄的增大,患儿出现肺部合并症(肺脓肿、胸腔积液、肺气肿、气胸)和右侧肺部病变比例逐渐增多(P<0.05);110例重症MPP患儿共检出病毒52例(47.3%),其中埃伯斯坦(EB)病毒感染最多23例(20.9%),其次巨细胞病毒(CMV)18例(16.4%),各年龄组混合病毒感染分布不平均;110例在应用强有力抗生素的基础上经加用肾上腺糖皮质激素,部分联用静脉滴注免疫球蛋白后均取得了肯定的治疗效果.结论 儿童重症MP P呈全年散发,以夏季多见;不同年龄阶段的儿童重症MP P临床特征存在不同,同时还存在混合感染现象.重症支原体肺炎CRP、LDH均明显升高.早期识别临床有重症肺炎支原体肺炎发展趋势的患儿,辅以联合治疗,可减少后遗症的发生.