小儿肺炎支原体肺炎诊治体会.pdf

GP Chinese General Practice
996
诊治分析
小儿肺炎支原体肺炎诊治体会
厉敏香,范铮,方成超
摘要】目的总结小儿肺炎支原体(MP)肺芙的临床特点和诊治效果。方法对2005年8月2010年8月
收治的180例MP肺英患儿的临床特点、实验室检查、治疗及效果进行总结与分析。结果本组病例的临床表现以发
热、刺激性咳嗽为主,肺部体征多不明显,外周血白细胞大多正常,红细胞沉降率及C反应蛋白(CRP)正常或稍升
高;X线胸片改变明显,此外尚有血液、肝功能、心肌、肾脏、神经系统等损害。恵者均行阿奇霉素治疗,部分患者
加用第三代头孢菌素、糖皮质激素,全部临床治愈。结论小儿MP肺炎好发于学岭儿童,小儿MP肺荧临床症状重而
体征轻,X线胸片阴彩明显是MP肺炎的特点,血清学检測为诊断的主要手段,大环内酯类抗生素是治疗的首选药物。
关鍵词】)小儿;肺炎支原体;肺类;诊断;治疗
【中图分类号】R725.631【文献标识码】B【文章编号】1007-9572(2011)03-0996-02
Clinical Diagnosis and Treatment of Infantile Mycoplasma Pneumoniae Pneumonia L Min-xiang, FAN Zheng, FANG
Cheng -. Depamen ofeditcs, ed Yuhang Hos, Medical ege of Normal niversity, Hangzhou
311100. China
Abstract] Objective To summarize the clinical features of infantile mycoplasma pneumoniae(MP)pneumonia an
its diagnosis and treatment. Methods The clinical features, laboratory examinations, reatment and outcomes of 180 MP in
fants admitted from August 2005 to August 2010 were analyzed. Results The main clinical manifestations of patients were fever
irritable cough, most with unobvious lung signs, normal peripheral blood leucocyte, and normal erythrocyte sedimentation rate
(ESR)and C-reactive protein (CRP)or a little increased. Chest X-ray films changed remarkably. In addition, damages of
blood, liver function cardiac muscle, kidney and nervous system, etc. were noted. Patients received azithromycin, some re
ceived additional third generation cephalosporin, glucocorticoids, and all cured clinically. Conclusion Infantile MP pneumon
a, predominantly occurring in the school-age children, has severe clinical symptoms but slight signs. Chest X-ray film having
obvious shadow is the characteristics of MP pneumonia. Serological test is the primary means of diagnosis and macrolide antibiot
ics is the first drug choice
Key words) Children; Mycoplasma pneumoniae; Pneumonia; Diagnosis; Therapy
肺炎支原体(MP)是近年来小儿呼吸道感染的重要病原片、肝肾功能、C反应蛋白、红细胞沉降率(血沉)、心肌酶
体之一の。小儿肺炎的发病率运年上升2,并且重症病例明谱、痰细菌培养、心电图、B超等检査,部分进行CT检查。
显增多。这些病例经大环内酯类抗生素治疗后体温下降缓慢,1.2方法对180例MP肺炎患儿的临床症状及实验室检查、
热程明显延长?,且易合并胸腔积液和肺不张。对本院2005治疗及其效果进行总结。
年8月-2010年8月确诊为MP肺炎的180例患儿临床资料进2结果
行总结,现分析报道如下。
2.1临床表现180例患儿均以发热咳嗽等呼吸系统症状为
1资料与方法
主要表现,其中发热伴咳嗽138例(76.67%),刺激性干咳
1.1一般资料180例小儿MP肺炎诊断标准参照第7版《诸为主135例(76.27%),中等程度发热88例(62.41%),反
福棠实用儿科学》“,均为儿科住院患者,其中男86例,女复咳嗽9例(21.67%),低熱33例(23.40%),高热20例
94例;其中年龄6个月-13例(7.22%),1~岁27例(14.18%),仅有发热3例(1.67%)。180例中57例
(15.00%),3-岁39例(21.67%),6~14岁101例(31.657%)有肺外症状,其中累及消化道20例(35.09%),
(56.11%)。采用日本富土MP诊断试验盒 SERODIA-MYCO表现为呕吐、腹泻;累及心血管系统15例(26.32%),表现
行颗粒凝集试验,阳性标准效价>1:40,所有患儿MP-IgM为胸闷、心悸、头晕、乏カ;累及胸膜8例(14.04%),表
均阳性。180例患儿均査血常规、尿常规、便常规、X线胸现为胸膜炎、胸腔积液;累及血液系统7例(12.28%);累
及泌尿系统5例(8.77%),表现为镜下血尿、蛋白尿;累及
作者单位:31100浙江省抗州师范大学医学院附属余杭医院
神经系统3例(5.26%),表现为精神娄靡、头痛、高热惊厥