低分子肝素辅助治疗D-二聚体升高的儿童重症肺炎支原体肺炎的疗效观察  

Efficacy of low molecular weight heparin in the treatment of severe mycoplasma pneumoniae pneumonia in children with elevated D-dimer

作　　者：张春峰 贺艺璇 吴润辉[2] 刘军[1] 郭琰[1] 殷菊[1] 刘秀云[1] Zhang Chunfeng;He Yixuan;Wu Runhui;Liu Jun;Guo Yan;Yin Ju;Liu Xiuyun(Department of Respiratory, Beijing Children 5 Hospital, Capital Medical University, National Center for Children 's Health, Beijing 100045, China)

机构地区：[1]首都医科大学附属北京儿童医院呼吸内科国家儿童医学中心,100045 [2]首都医科大学附属北京儿童医院血液科,100045

出　　处：《北京医学》2019年第3期183-186,共4页Beijing Medical Journal

摘　　要：目的评价低分子肝素辅助治疗D-二聚体升高的儿童重症支原体肺炎的临床效果。方法收集2009年1月至2017年7月首都医科大学附属北京儿童医院呼吸科收治的287例轻症支原体肺炎(mycoplasma pneumoniae pneumo?nia, MPP)和247例重症支原体肺炎(severe mycoplasma pneumoniae pneumonia, SMPP)患儿的临床资料,MPP组采用常规抗感染治疗,SMPP组根据是否应用低分子肝素分为两个亚组,比较轻症MPP组、SMPP低分子肝素组与SMPP非低分子肝素组的实验室检查指标、影像学表现,比较SMPP低分子肝素组与非低分子肝素组治疗后的病情转归。结果 SMPP低分子肝素组治疗前的D-二聚体[4.41(0.85,29.34)mg/L]显著高于非低分子肝素组[1.89(0.11,11.08)mg/L,P=0.000]及轻症MPP组[0.50(0.04,2.99)mg/L,P=0.000]。SMPP低分子肝素组肺不张发生率(38.3%vs. 26.0%, P<0.05)和发热天数[(14.13±9.20)d vs.(11.94±9.37)d,P<0.05]显著高于非低分子肝素组;但治疗后住院天数显著低于非低分子肝素组[(20.54±11.47)d vs.(21.93±16.10)d],影像学病变明显吸收率(83.3%)高于非低分子肝素组(69.3%),差异均有统计学意义(P<0.05)。结论 SMPP患儿早期使用低分子肝素有助于加速肺部病变吸收,缩短住院时长,改善预后。Objective To evaluate the clinical efficacy of low molecular weight heparin (LMWP) in the treatment of severe mycoplasma pneumoniae pneumonia (SMPP) in children with elevated D-dimer. Methods A total of 247 cases of SMPP with elevated D-dimer and 287 cases of mycoplasma pneumoniae pneumonia (MPP) in Beijing Children 's Hospital from January 2009 to July 2017 were selected. The SMPP patients were divided into two groups according to whether using LMWP. Laboratory examination and image changes before treatment were compared between three groups and the duration of fever, hospital stay, the incidence of atelectasis, and image changes after treatment were also compared. Results The level of D-dimer [4.41(0.85,29.34)mg/L] in LMWP group was higher than that of non-LMWP group [ 1.89(0.11,11.08)mg/L, P = 0.000] and MPP group [0.50(0.04,2.99)mg/L, P = 0.000]. The incidence of atelectasis in LMWP group was higher than that of non- LMWP group (38.3% vs. 26.0%, P < 0.05), the duration of fever was longer than that of non- LMWP SMPP group [(14.13±9.20) d vs.(11.94±9.37) d, P< 0.05]. While the imaging improvement rate in LMWP group was higher than that of non-LMWP group (83.3% vs. 69.3%, P < 0.05), the hospital stay in LMWP group was less than that of non-LMWP group [(20.54±l 1.47) d vs.(21.93±16.10) d, P< 0.05]. Conclusions Early use of LMWH can accelerate the absorption of lung lesions, shorten hospitalization time and improve prognosis for SMPP children.

关 键 词：重症支原体肺炎 低分子肝素 儿童 D-二聚体 

分 类 号：R725.6[医药卫生—儿科]