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目的总结重症肺炎支原体肺炎(MPP)的治疗经验,以提高临床诊治水平。方法选取2009年1月至2010年12月儿科病房收治的58例重症MPP患儿为分析对象,所有患儿早期静脉滴注红霉素10～12d,病情恢复期静脉滴注阿奇霉素3d停4d,同时联合静脉滴注头孢三代或四代抗生素,其中24例持续高热、病情重的患儿联合静脉注射人血丙种球蛋白(IVIG)及甲基强的松龙治疗。结果重症MPP临床表现持续高热7～15d,刺激性频咳;肺CT示58例肺叶大片状致密阴影,部分见肺不张、胸腔积液,个别见心包积液;均伴有多系统损害,心肌损害为明显,其次为肝、肾、血液系统等。治愈52例,好转4例,2例肺不张未完全恢复,出院后半个月复诊基本痊愈。心肌损害40例中,6例患儿出院时心肌酶未完全恢复,继续口服营养心肌药,1～3个月复诊恢复正常。结论重症MPP病情重,病程长,多合并多系统损害,应予以重视,联合应用IVIG及甲基强的松龙治疗效果满意,副作用少。
Objective To summarize the experience of treatment of severe mycoplasma pneumoniae pneumonia (MPP) in order to improve the level of clinical diagnosis and treatment. Methods Fifty-eight cases of severe MPP admitted to pediatric ward from January 2009 to December 2010 were enrolled in this study. All patients received early intravenous infusion of erythromycin for 10-12 days. Azithromycin was given intravenously for 4 days after convalescent recovery. At the same time, intravenous infusion of three generations of cephalosporins or four antibiotics, including 24 cases of persistent high fever, severe cases of children with intravenous injection of human blood gamma globulin (IVIG) and methylprednisolone treatment. Results The clinical manifestations of severe MPP sustained high fever 7 ~ 15d, irritating cough; lung CT showed 58 lobular large dense shadow, in part see atelectasis, pleural effusion, see individual pericardial effusion; are associated with multiple system damage , Myocardial damage was obvious, followed by liver, kidney, blood system and so on. 52 cases were cured, 4 cases improved, 2 cases of atelectasis did not fully recover, half a month after discharge, the basic recovery of referral. Myocardial damage in 40 cases, 6 patients discharged from cardiac enzyme not fully recovered, continue to oral nutritional cardiomyopathy, 1 to 3 months follow-up returned to normal. Conclusions Severe MPP is seriously ill, has a long course of disease and should be treated with multiple systematic injuries. It is concluded that the combination of IVIG and methylprednisolone is satisfactory and the side effects are few.