儿童重症肺炎支原体肺炎致不同类型脑梗死3例  

Different types of cerebral infarction caused by severe mycoplasma pneumoniae pneumonia in 3 children

作　　者：王媛媛 崔俊岭[2] 崔晓薇[1] WANG Yuanyuan;CUI Junling;CUI Xiaowei(Department of Neurology,Hebei Children’s Hospital,133 Jianhua South Street,Shijiazhuang 050004,China)

机构地区：[1]河北省儿童医院神经内科,河北省小儿癫痫与神经疾病重点实验室,石家庄050004 [2]河北医科大学第二医院神经外科

出　　处：《中国神经精神疾病杂志》2024年第2期110-113,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：河北省医学科学研究重点课题计划(编号:20190520)。

摘　　要：总结3例儿童重症肺炎支原体肺炎致腔隙性脑梗死、大脑中动脉下干梗死、分水岭脑梗死的患儿临床特征及诊治结局。3例患儿均因发热、咳嗽为主诉收入院。住院期间出现活动不利等神经系统症状,完善头部影像学后确诊为脑梗死。病例1,男,5岁,腔隙性脑梗死同时合并有心房血栓及上肢动脉血栓。病例2,男,5岁,大脑中动脉下干梗死;病例3,女,4岁,分水岭脑梗死。病例2、3在行纤维支气管镜后出现神经系统症状。3例患儿D-二聚体水平均异常升高。肺炎支原体感染急性期可致各种类型脑梗死,不同类型脑梗死存在不同的致病机制。肺炎支原体肺炎诊疗过程中需检测D-二聚体水平、及时完善心脏超声,术前注意患儿出入量及灌注水平,避免脑梗死的发生。To summarize the clinical features and treatment outcomes of 3 children with lacunar cerebral infarction,middle inferior cerebral trunk infarction and watershed cerebral infarction caused by severe mycoplasma pneumoniae pneumonia.All the 3 cases were admitted to hospital due to fever and cough.Patients developed neurological symptoms such as poor activity during hospitalization and was diagnosed with cerebral infarction after head imaging.Case 1,a 5-year-old boy,had lacunar cerebral infarction combined with atrial thrombosis and upper limb arterial thrombosis.Case 2,a 5-year-old boy,had a middle inferior cerebral trunk infarction;Three 4-year-old girls had watershed cerebral infarction.Cases 2 and 3 developed neurological symptoms after fiberoptic bronchoscopy.D-dimer levels were abnormally elevated in all 3 cases.The acute stage of mycoplasma pneumoniae infection can cause various types of cerebral infarction,and different types of cerebral infarction have different pathogenic mechanisms.During the diagnosis and treatment of mycoplasma pneumoniae pneumonia,it is necessary to detect the D-dimer level in time and perform cardiac ultrasound,and pay attention to the intake and outflow level and perfusion level of children before surgery to avoid the occurrence of cerebral infarction.

关 键 词：肺炎支原体肺炎 儿童脑梗死 分水岭脑梗死 腔隙性脑梗死 大脑中动脉脑梗死 D-二聚体低灌注 

分 类 号：R563.1[医药卫生—呼吸系统] R743[医药卫生—内科学]