儿童肺炎支原体脑炎25例临床治疗及护理要点分析  

Analysis of clinical treatment and nursing of 25 children with mycoplasma pneumoniae encephalitis

作　　者：肖静[1] 李鹏[1] 

机构地区：[1]青岛市第八人民医院,266100

出　　处：《中国实用医药》2017年第21期121-122,共2页China Practical Medicine

摘　　要：目的探讨儿童肺炎支原体(MP)脑炎的临床特点及护理要点。方法回顾性分析25例肺炎支原体脑炎患儿的临床表现、实验室检查、治疗、转归情况,总结儿童肺炎支原体脑炎的临床特点及护理要点。结果肺炎支原体脑炎多见于学龄期儿童,临床表现为头痛、呕吐(72.0%),发热(88.0%),抽搐(36.0%),昏迷(12.0%),嗜睡、精神萎靡(8.0%),肢体活动障碍(4.0%)。22例血清抗肺炎支原体抗体免疫球蛋白M(MP-Ig M)阳性,9例脑脊液抗MP-Ig M阳性,其中6例血和脑脊液抗MP-Ig M均阳性。20例拍摄胸片,16例异常。16例检查C反应蛋白(CRP)均升高。头颅磁共振成像(MRI)阳性率为60.0%(15/25)。25例患儿均临床症状好转,脑脊液常规复查正常后出院,继续巩固治疗,随访0.5年,仅1例有轻度肢体活动障碍,余患儿均无后遗症。结论中枢神经系统感染患儿如果脑脊液呈病毒性脑炎改变,胸片检查有肺炎X线表现,CRP升高,要考虑肺炎支原体感染可能。MRI检查有助于诊断肺炎支原体脑炎,确诊有赖于血清和(或)脑脊液抗MP-Ig M检查,早期治疗与良好护理均可取得理想的预后效果。Objective To investigate the clinical features and nursing points of children with mycoplasma pneumoniae （MP） encephalitis. Methods A retrospectively analysis was made on clinical manifestation, laboratory examination, treatment and prognosis of 25 children with mycoplasma pneumoniae encephalitis. The clinical features and nursing points of children with mycoplasma pneumoniae encephalitis were summarized. Results Mycoplasma pneumoniae encephalitis is common in school-age children, and the clinical manifestations were headache and vomiting （72.0%）, fever （88.0%）, convulsions （36.0%）, coma （12.0%）, lethargy and malaise （8.0%） and limb dysfunction （4.0%）. There were 22 cases of positive serum anti-Mycoplasma pneumoniae antibody IgM （MP-IgM）, 9 cases of positive cerebrospinal fluid anti-MP-IgM, including 6 cases of positive blood and cerebrospinal fluid anti-MP-IgM. Chest radiography was performed in 20 cases, and 16 cases were abnormal. The C- reactive protein （CRP） was elevated in 16 cases. The positive rate of cranial magnetic resonance imaging （MRI） was 60.0% （15/25）. 25 cases of children had improved clinical symptoms. They discharged after cerebrospinal fluid routine examination, and continue to consolidate treatment. After 0.5 years of followed-up, only 1 case of mild physical activity disorder, and the remaining children had no sequelae. Conclusion For children with central nervous system infection, if their cerebrospinal fluid is viral encephalitis changes, along with pneumonia manifestation by chest X-ray examination and increased CRP, the possibility of mycoplasma pneumoniae infection should be considered. MRI examination is helpful for the diagnosis of mycoplasma pneumoniae encephalitis. The confirmed diagnosis depends on the serum and/or cerebrospinal fluid anti-MP-IgM test. Early treatment and good nursing can achieve ideal prognosis.

关 键 词：肺炎支原体脑炎 儿童 肺炎支原体抗体 

分 类 号：R473.72[医药卫生—护理学]