常量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗方案探讨  

Clinical Characteristics and Scheme for Refractory Mycoplasma Pneumoniae Pneumonia in Children of Invalid Treatment with Constant Methyl Prednisolone

作　　者：陈丽兰[1] 

机构地区：[1]广西壮族自治区北海市人民医院儿科,广西北海536000

出　　处：《河北医学》2016年第1期147-150,共4页Hebei Medicine

基　　金：广西壮族自治区科技厅计划资助基金项目;(编号:2012060212)

摘　　要：目的:探讨常量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎的临床特征和治疗方案。方法:选择来我院就诊的难治性肺炎支原体肺炎患儿124例作为研究对象,根据治疗效果,分为观察组与对照组。比较两组患者的体温情况、实验室检查、影像学检查、支气管镜检查与混合感染情况。同时对观察组患者进行后续治疗,观察疗效。结果:观察组患儿体温高于40℃的比例明显高于对照组,差异有统计学意义(P<0.05)。同时,观察组患者血液中白细胞数、C反应蛋白、肌酸激酶同工酶、血清铁蛋白与纤维蛋白含量均明显升高。影像学结果表明,观察组患儿多表现为整叶以上肺部实变,且肺组织坏死率增加。与对照组相比,观察组患儿更易出现分泌物阻塞、内膜坏死与支气管闭塞等严重并发症。通过合理增加甲泼尼龙用量或采用丙种球蛋白控制炎症反应后,观察组患儿病情均得到有效改善,体温基本恢复正常。结论:常量甲泼尼龙治疗无效的儿童难治性肺炎支原体肺炎多表现为体温高热,炎症反应指标异常,肺部实变范围增大,肺组织坏死率高,容易引起混合感染,需及时调整药物用量,以减少并发症的发生,改善预后。Objective： To investigate the clinical characteristics and scheme for refractory mycoplasma pneumoniae pneumonia in children of invalid treatment with constant methyl prednisolone. Method： 124 cases of children with refractory mycoplasma pneumoniae pneumonia were selected,and according to the treatment effect,were divided into observation group and control group. The temperature,laboratory examination,imaging examination,bronchoscopy and mixed infection of the two groups were compared. After subsequent treatment was given to the observation group,curative effect was observed.Result： The proportion of observation group temperature was obviously higher than that of the control group,the difference was statistically significant（ P〈0. 05）. At the same time,the blood leukocyte count,c-reactive protein,creatine kinase isoenzyme,serum ferritin and fibrous protein content in the observation group was significantly increased.Imaging showed that more consolidation of the lung,and lung tissue necrosis rate in the observation group increased.Compared with the control group,observation group was more likely to appear secretion obstruction,endometrium necrosis with serious complications such as bronchial occlusion.By reasonablly increased dosage of armour prednisolone or after using gamma globulin control inflammation,the conclition of the observation group was effectively improved,body temperature was basically returned to normal.Conclusion： Children with refractory mycoplasma pneumoniae pneumonia invalid treatment treated with constant methyl prednisolone has higher temperature,abnormal inflammation index,increased scope of consolidation of the lung,higher lung tissue necrosis rate,easier mixed infection,which need to adjust drug dosage to reduce complications and improve prognosis.

关 键 词：甲泼尼龙 难治性肺炎 支原体肺炎 

分 类 号：R725.6[医药卫生—儿科]