儿童肺炎支原体感染相关的坏死性肺炎临床分析  

Clinical Analysis of Children Necrotizing Pneumonia Caused by Mycoplasma pneumoniae

作　　者：王永军 李万怡[1,2] 王文媛 王舒颖 赵启君 易彬 刘东海 WANG Yongjun;LI Wanyi;WANG Wenyuan;WANG Shuying;ZHAO Qijun;YI bin;LIU Donghai(The First Clinical Medical College of Gansu University of Traditional Chinese Medicine,Gansu Lanzhou 730000,China;Second Department of Pediatric Respiratory Medicine,Gansu Maternal and Child Health Hospital,Gansu Lanzhou 730050,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃兰州730000 [2]甘肃省妇幼保健院小儿呼吸二科,甘肃兰州730050

出　　处：《中国医药导刊》2022年第4期384-388,共5页Chinese Journal of Medicinal Guide

摘　　要：目的:探讨儿童肺炎支原体(MP)感染相关的坏死性肺炎(NP)的临床特征。方法:收集我院2017——2020年收治的30例儿童MP感染相关的NP患儿及同时期30例普通肺炎患儿的临床资料,回顾性分析其一般资料、临床表现、实验室检查、影像学检查、治疗及预后。结果:NP患儿相较于普通肺炎患儿,发热、气促/呼吸困难、肺外并发症及呼吸音减低等临床表现比率、发热时长、氧疗时间差异均有统计学意义。NP患儿血清白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)、乳酸脱氢酶(LDH)水平均明显升高,且CRP以大于100 mg·L^(-1)的患儿较多。76.6%NP患儿合并胸腔积液,胸腔积液中白细胞数、LDH及白蛋白也明显升高。所有NP患儿胸部影像学检查及支气管检查均较重,从症状开始到发现坏死出现的平均时间为(25.7±6.9)d。所有NP患儿均给予抗生素治疗,60%NP患儿给予糖皮质激素治疗,93.3%NP患儿行支气管镜检查及肺泡灌洗。20例NP患儿行胸膜腔穿刺术,3例行胸腔闭式引流术。所有NP患儿病灶吸收,预后良好。结论:儿童MP感染相关的NP病程长、病情重,但经积极治疗后预后良好。Objective:To investigate the clinical features of necrotizing pneumonia(NP)caused by Mycoplasma pneumoniae(MP).Methods:The clinical date of 30 case children with NP caused by MP and 30 children with common pneumonia in our hospital from 2017 to 2020 were collected.The general data,clinical manifestations,laboratory examination data,imaging examination data,treatment and prognosis of the patients were analied retrospectively.Results:Compared with children with common pneumonia,the ratio of clinical features such as fever,shortness of breath/dyspnea,extra-thoracic complications and reduced breath sounds in NP children had statistical difference,and the duration of fever and oxygen therapy also statistical difference.Children with NP had significantly increased WBC,CRP,PCT,ESR,LDH level,and more children with CRP greater than 100 mg·L^(-1).76.6%of the NP children had pleural effusion,and the level of WBC,LDH and albumin in pleural effusion also increased significantly.All the NP children′s chest imaging and bronchial examinations were serious.The average time from the onset of symptoms to the appearance of necrosis was(25.7±6.9)d.All the NP children were treated with antibiotics,60%of the NP children were treated with glucocorticoid treatment,and 93.3%of the NP children were treated with bronchoscopy and alveolar lavage.20 cases of the NP children were treated undergoing pleural cavity puncture and 3 cases the NP children were treated of pleural closed drainage.All the NP children′s lesions were absorbed and they had good prognosis.Conclusion:The NP clildren caused by MP is long and severe,but the prognosis is good after active treatment.

关 键 词：肺炎支原体 儿童 坏死性肺炎 

分 类 号：R722[医药卫生—儿科] R725.6[医药卫生—临床医学]