摘要
目的探讨小儿肺炎支原体肺炎（MPP）的临床特点。方法选取2013年5月~2014年8月在本科住院的85例MPP患儿作为研究对象,分析其临床资料。结果首发症状多为发热和咳嗽,高热占55.29%,婴幼儿喘憋明显者占22.35%。37例（43.53%）存在肺外并发症,主要为消化道症状（21.18%）,此外尚有血液系统、神经系统、心血管系统等,肺部体征多不明显。血白细胞正常或轻度增高,血清C反应蛋白多有升高;肺部X线异常率明显高于肺部体征阳性率,其表现呈多样性,病变部位以单侧为主（60.0%）,其中以下肺多见（41.18%）,且右侧（38.82%）多于左侧。血清MP检测是临床最常用的特异诊断方法 ,Ig M-MP≥1∶160或动态观察呈倍数递增即可确诊,但是Ig M-MP的阳性率在病初1周内很低（20.0%）。入院后均给予阿奇霉素10 mg/（d·kg）静脉滴注5 d停3 d为第1个疗程,根据病情再次静脉使用或改为口服阿奇霉素10 mg/（d·kg）3 d停3 d,直至病情恢复正常;合并细菌感染加用第二代头孢菌素治疗;中毒症状重、高热不退、有胸膜反应、肺部病变广泛、明显喘憋者给予激素治疗。结论小儿MPP好发于学龄儿童,但近年来出现低龄化趋势。临床症状和体征不平衡,影像学表现多样,血清学检测为诊断的主要手段,大环内酯类抗生素是治疗的首选药物,对于难治性、重症MP感染及合并肺外损伤者,可加用激素或丙种球蛋白,起免疫调节和抗炎作用。
Objective To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia（MPP） in children.Methods 85 cases of MPP from August 2014 to May 2013 in our department were selected as the research object,and the clinical data were analyzed. Results The starting symptoms were more fever and cough,hyperpyrexia accounted for55.29%.Infants with significantly asthma accounted for 22.35%.37 cases（43.53%） had extrapulmonary complications,and the main was gastrointestinal symptoms which had a higher rate（21.18%）.In addition,there were blood system,nervous system and cardiovascular system.Most with unobvious lung signs.The blood leucocyte was normal or a little increased.Serum C-reactive protein was most increased.The abnormal rate of lung X-ray was significantly higher than the rate of positive lung signs,and its performance was diversity.The pathological changes were mainly in unilateral accounted for 60.0%.Among the unilateral pathological changes,the pathological changes were more appeared in lower lung and right lung（38.82%） and were more than left lung.Serum MP detection was the most common specific clinical diagnosis method,which could make a definite diagnosis when Ig M-MP≥1∶160 or Ig M-MP increased multiple in dynamic observation,but the positive rate of Ig M-MP was very low at the beginning of the disease within 1 week（20.0%）.All patients intravenous dripped azithromycin of 10（mg/d·kg） for 5 days and stopped for 3 days as the first course.According to the illness,intravenous dripped azithromycin again or change to oral azithromycin of 10（mg/d·kg） for 3 days and stopped 3days,until the illness recovery.Patients with bacteria infection could treat with the second generation cephalosporins.Patients with poisoning symptoms,high fever was not retreated,pleural reaction,extensively lung disease,significantly asthma could give hormone treating. Conclusion Children MPP more appears among school-age children,but it has a tendency to younger age.For children MPP,its clinical signs and symptoms are not balance,radiographic appearance are diversity,the mainly diagnosis method is serological detection,the choice drug for treatment is large ring lactone class antibiotic.For refractory children MPP,severe MPP infection and extrapulmonary injuries,can further treatment with hormone or gamma globulin to play a role of immune regulation and anti-inflammatory.
出处
《中国当代医药》
2015年第25期93-96,99,共5页
China Modern Medicine
关键词
肺炎支原体
发病机制
临床特征
诊断及治疗
Mycoplasma pneumoniae pneumonia
Pathogenesis
Clinical characteristics
Diagnosis and therapy
