摘要
目的探讨以节段性炎症改变为特点的儿童肺炎支原体肺炎(MPP)的临床表现、影像学特征及肺功能改变。方法收集本院儿科病房明确诊断为MPP肺炎,且胸部CT证实为节段性炎症改变的143例患儿,对其临床特征、实验室检查、CT表现及治疗转归情况进行分析,并对其中的部分患儿进行急性期与恢复期的肺功能检测分析。结果143例MPP患儿主要表现为发热、咳嗽、肺部一过性啰音,50例有肺外表现。胸部CT主要表现为大片状模糊影和肺实变,且在此基础上可合并多种改变。病变可累及肺部各个叶段,其中右肺多于左肺,下肺多于上肺,以右下肺最多见。急性期肺功能可为正常、限制性障碍和混合性障碍,一秒钟用力呼气量、用力肺活量、最大呼气流量、25%用力呼气肺活量、50%用力呼气肺活量和75%用力呼气肺活量和最大中期呼气流速均明显降低。3周后,20例患儿复查肺功能,其中85.0%患儿已恢复正常。经大环内酯类药物治疗,61.5%患儿临床症状和肺部体征消失,其他患儿在加用头孢类抗生素或(和)激素后症状和体征得到控制。结论儿童MPP可表现为节段性炎症改变,其临床表现严重且多样化,肺功能有不同程度的损害。对大环内酯类药物治疗效果不理想的患儿,可以考虑联合使用头孢类抗生素和(或)激素治疗。
Objective To explore the clinical manifestation, chest radiographic features and lung function changes of mycoplasma pneumoniae pneumonia （MPP） with segmental inflammation in children. Methods One hundred and forty - three children were clearly diagnosed as MPP shown segmental inflammation by chest CT in pediatric wards of the Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University. The clinical characteristics,laboratory tests,chest CT and treatment of these children were analyzed. The lung function of the acute phase and recovery phase in some of these children were also tested. Results The main manifestation of 143 cases of MPP included fever, cough,temporary cralks of lung and extrapulmonary presentations. The appearance of chest CT included large lamellar effusion,consolidation of lung and more changes based on them. Pathological changes involved different segment of lung. Right lung was more easily involved than the left, the lower was more than the upper, and the lower of right lung was the most easily involved. The result of lung function tests included normal, confine disorder and combined disorder in acute stage. Forced expiratory volume in first second ,forced vital capacity, peak expiratory flow ,25% forced exporatory flow ,50% forced expiratory flow and 75% forced expiratory flow and forced expiratory flow during middle half of FVC were decreased obviously. Lung function of 85.0% patients of 20 cases recovered. The clinical symptoms and lung signs could be cured after treated with macrolides in 61.5% of children,the others had to add cephalosporins and（or） eorticosteroid to control symptoms and signs. Conclusions MPP with segmental inflammation changes in children showed severe and varied clinical manifestation, and impairment of lung function in acute stage. Most of them could recover in 3 weeks after disappears of clinical symptoms and lung signs. The combination of cephalosporins and（or） corticosteroid might consider for the cases who had no effect with macrolides.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第4期259-261,共3页
Journal of Applied Clinical Pediatrics
关键词
肺炎支原体
节段性炎症
肺功能
胸部CT
mycoplasma pneumoniae
segmental inflammation
lung function
chest CT
