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1、12例儿童难治性支原体肺炎临床分析张艳萍(安阳市第六人民医院儿科河南安阳455000)【摘要】目的探讨难治支原体肺炎的临床表现、诊断依据和治疗方法。方法回顾12例难治和重症支原体肺炎的临床表现、诊疗经过，查阅相关文献进行分析讨论。结果12例患儿年龄3-12岁，年龄偏大，咳嗽程度不等；反复发热持续时间大于10天7例，小于10天4例，无发热1例；肺部CT,1例表现支气管炎,4例支气管肺炎，7例显示程度不等的肺叶实变，其中2例累及双肺，1例发生肺纤维化；5例合并少-中等量胸腔积液，1例出现大量胸腔积液；外周血白细胞计数增高9例，正常3例；CRP正常2例，增高
2、10例；中度贫血1例；心肌酶升高7例；谷丙转氨酶增高2例，尿蛋白阳性1例。12例患儿应用大环内酯类抗菌素均超过7天，8例联合应用了头孢类抗菌素，7例应用了肾上腺皮质激素甲强龙，3例输用丙种球蛋白,1例同时输用血浆，同时合并贫血，输用了压积红细胞，其中3例转上级医院，随访最后1例发生肺纤维化。结论难治性支原体肺炎发病年龄偏大，年龄范围较窄，容易转为重症，合并感染，合并肺外并发症，要注意早期识别，必要时可加用肾上腺皮质激素，输用丙种球蛋白等，合并细菌感染必要时可联合应用抗蘭素。【关键词】儿童支原体肺炎临床分析【中图分类号】R730.5【文献标识码】A【文章
3、编号】2095-1752(2013)25-0157-01Clinicalanalysisof12casesofseveremycoplasmapneumoniaofchildren.ZhangYanping.DepartmentofPediatrics,theSixthPeople,sHospitalofAnyangCity,HenanAnyang455000.【Abstract】ObjectiveToexplorethediagnosisandtreatmentofseveremycoplasmapneumoniaofchildren.Methods
4、Clinicalmanifestations,diagnosisandtreatmentof12casesofseveremycoplasmapneumoniaofchildrenwerereviewed.Results12chilidrenwere3-12yearsold,coughedinvariety.7caseshadbeenfeveringformorethan10days,4caseslessthan10daysand1casesnofever.LungCT,onecasemenifestedbronchitis,4casesbronchi
5、alpneumoniaand7casesconsolidationoflobipulmonis.5caseshadsmall–mediumpleuraleffusionand1caseagreatdeal.Peripheralwhitebloodcellcountsof9casesrisedand3caseswerenormal.2caseshadnormalCRPand10casesrised.1casewascomplicatedbymoderateanemia.7casesMyocardialenzymeand2casesglutam
6、ic-pyruvictransaminaserised.1caseurineproteinwaspositive.12patientswithmacrolidesantibioticsweremorethan7days,and8casescephalosporinantibioticswerecombined.7casesmethylprednisoloneswereapplied.3patientsreceivedgammaglobulin,angoneofthemreceivedbloodplasmaandpackedredcells.3sever
7、epatientsweretransferredtootherhospitals.Attheendpulmonaryfibrosiswasformedinoneofthem.ConclusionsTheagesofmostofthepatientswithrefractorymycoplasmapneumoniaareelder.Thesecasesmaydevelopsevere,orbecombinedwithotherinfectionsanddamagesofotherorgans.Weshouldbeawareattheerliertime.
8、Ifnecessary,adrenalcortexhormone,gammaglobulina
