儿童重症肺炎支原体肺炎的临床特点及预后  

Clinical features and follow-up of severe Mycoplasma pneumoniae pneumonia in children

作　　者：俞珍惜[1] 刘秀云[2] 彭芸[2] 江载芳[2] 

机构地区：[1]杭州市第一人民医院儿科,浙江杭州310006 [2]首都医科大学附属北京儿童医院呼吸内科,北京100045

出　　处：《临床儿科杂志》2011年第8期715-719,共5页Journal of Clinical Pediatrics

摘　　要：目的总结儿童重症肺炎支原体肺炎(MPP)急性期的临床特点以助临床早期评估和治疗,并了解其转归。方法回顾性分析北京儿童医院呼吸科病房101例重症MPP患儿(重症组)和102例轻症MPP患儿(对照组)的住院病例资料,包括症状和体征、影像学表现及肺内外并发症等临床特点,并对其中16例重症MPP患儿进行肺部高分辨CT及肺功能的随访。结果重症MPP多表现为咳嗽、高热,热程长,易出现气促、心动过速,甚至可有发绀及三凹征,肺部影像学常表现为大片状阴影,伴或不伴有肺不张、胸腔积液及坏死性肺炎/肺脓肿等肺内并发症,也可导致呼吸、神经、循环、消化、泌尿等系统功能严重损害。在重症MPP患儿中有16.3%出现闭塞性支气管炎(15/92)。16例重症患儿平均随访(9.81±3.85)个月,仅3例肺内病变基本吸收好转,肺功能正常;余13例肺部高分辨CT均有肺不张,其中7例合并支气管扩张,5例伴限局性气体潴留,肺功能异常8例。结论对于临床症状重、热程长、肺部影像学为大片状阴影,伴有肺不张、胸腔积液及坏死性肺炎/肺脓肿等肺内并发症或伴有系统功能严重损害的儿童MPP,应高度注意重症MPP的可能性并予以尽早治疗。重症MPP可遗留肺结构和(或)功能损害,需对其进行肺部高分辨CT和肺功能的长期随访。Objective To summarize and analyze the clinical features of severe Mycoplasma pneumoniae pneumonia（MPP）at acute phase in children.Methods A retrospective study of children with MPP was performed to 101 severe cases and 102 control cases of pulmonary department of Beijing Children＇s Hospital from January 2009 to January 2010.The clinical features of the two groups,including symptoms and signs,radiology,intrapulmonary and extrapulmonary complications were studied.And 16 cases with severe MPP was followed up by High Resolution CT and pulmonary function testing.Results Severe MPP cases were always presented with cough,long-lasted high fever,tachypnea and tachycardia,and cyanosis and retraction signs.The imaging manifestations are presented with large patchy shadow,with or without atelectasis,pleural effusion,necrotizing pneumonia or lung abscess.And it also can lead to severe multi-disorders in respiratory,nervous,circulatory,digestive and urinary systems.There were 15 cases of bronchitis obliterans in 92 cases of severe MPP（16.3%）diagnosed by bronchofiberoscope.During follow-up,16 cases with severe MPP（the mean time of follow up is 9.81 ± 3.85 mo.after onset）,only 3 cases had nearly recovered,the other 13 cases all presented with atelectasis,of which 7 cases with bronchiectasis and 5 cases with the areas of air trapping,and among 13 cases,abnormalities were found in 8 cases under pulmonary function testing.Conclusions Severe MPP should be considered and treated as early as possible when those clinical features emerges.Severe MPP may result in structural lesions and/or abnormal function in lung tissues,it＇s important to follow up with high resolution CT and pulmonary function testing for long-term.

关 键 词：儿童 肺炎 肺炎支原体 重症 

分 类 号：R725.6[医药卫生—儿科]