小儿肺炎支原体肺炎85例临床剖析.docVIP

小儿肺炎支原体肺炎85例临床剖析 　　[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，IgM-MP≥1∶160或动态观察呈倍数递增即可确诊，但是IgM-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。 　　[关键词] 肺炎支原体；发病机制；临床特征；诊断及治疗 　　[中图分类号] R725.6 [文献标识码] A [文章编号] 1674-4721（2015）09（a）-0093-05 　　[Abstract] 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 for 55.29%.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 IgM-MP≥1∶160 or IgM-MP increased multiple in d