本文選題：肺炎支原體肺炎 + 發(fā)病機制��； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:探討分泌物堵塞氣道的兒童肺炎支原體肺炎的臨床危險因素及轉歸。方法:回顧性分析2016年9月至2017年1月我院小兒呼吸科收治的130例行纖維支氣管鏡灌洗術的肺炎支原體肺炎(MPP)患兒的臨床資料,根據支氣管鏡下有無分泌物堵塞氣道分為氣道堵塞組與對照組,對比兩組患兒的臨床表現、實驗室檢查、鏡下改變、影像學特征及轉歸情況,對堵塞組MPP行多因素Logistic回歸分析,并繪制ROC曲線,尋找分泌物堵塞氣道的兒童MPP的各獨立危險因素的臨界值。結果:1.性別和年齡:兩組在性別、年齡方面差異無統(tǒng)計學意義(P0.05),兩組患兒發(fā)病年齡均以6歲以上為主。2.臨床癥狀和體征:堵塞組與對照組相比較,熱峰[39.8(39.5,40.0)比39.5(39.0,39.8),P0.05]、熱程(11.3±3.1比7.8±2.4,P0.05]、呼吸音減弱的比例(80.0%比41.4%,P0.05)、叩診濁音或實音比例(56.7%比14.3%,P0.05)均高于對照組。3.實驗室檢查:堵塞組外周血白細胞總數(9.4±3.7比8.2±2.9,P0.05)、中性粒細胞百分比(69.8±11.2比62.3±11.9,P0.05)、C反應蛋白(CRP,mg/L)[48.2(19.8,91.0)比12.4(7.1,25.4),P0.05]、乳酸脫氫酶(LDH,U/L)[466.5(371.5,639.0)比323.0(273.2,376.8),P0.05]、D-二聚體(ug/L)[1002.0(577.50,2042.0)比352.5(198.5,573.8),P0.05]均高于對照組。4.影像學表現:兩組患兒肺部影像學均表現為大片狀高密度影,堵塞組患兒合并胸腔積液、累及肺葉≥2、肺不張的比例均高于對照組(P0.05),堵塞組10%患兒合并肺壞死,對照組未見肺組織壞死。5.纖維支氣管鏡下表現及痰栓病理:堵塞組纖維支氣管鏡下均可見痰栓堵塞氣道,以右上肺、左下肺為主,其中3例可見樹枝樣痰栓,5例可見支氣管閉塞,對照組鏡下氣道內可見絮狀漂浮物,未見支氣管閉塞。3例樹枝樣痰栓病理均為炎性壞死組織,可見纖維素、中等量中性粒細胞及淋巴細胞浸潤。6.治療及轉歸:堵塞組住院時間高于對照組(13.5±3.8比8.5±3.2,P0.05)。兩組患兒其中44例(33.8%)在第1次肺泡灌洗后1~3d體溫恢復正常,其中堵塞組22例,對照組22例。所有患兒均好轉出院。有效隨訪120例患兒至出院后1個月復查肺部影像學,肺部炎癥完全吸收比例對照組高于堵塞組(84.4%比53.6%,P0.05)。7.堵塞組患兒均為難治性肺炎支原體肺炎(RMPP),對照組有67.1%患兒為RMPP。對有意義的單因素變量行Logistic回歸分析,顯示熱程、CRP、LDH為分泌物堵塞氣道的兒童MPP的獨立危險因素,其ROC曲線臨界值分別為9.5天、30.35mg/L、343.5U/L。結論:1.分泌物堵塞氣道的兒童MPP熱程、熱峰、住院時間、WBC、NE%、CRP、LDH、D-二聚體、合并呼吸音減弱、叩診濁音或實音、胸腔積液、肺不張、炎癥累及肺葉≥2的比例均明顯高于對照組,且堵塞組患兒均為難治性肺炎支原體肺炎。2.熱程≥9.5天、CRP≥30.35mg/L、LDH≥343.5U/L是分泌物堵塞氣道的兒童MPP危險因素,可作為預測指標。3.分泌物堵塞氣道的兒童MPP肺部炎癥重,病灶吸收慢,發(fā)生壞死性肺炎、閉塞性支氣管炎的可能性大,建議積極行纖維支氣管鏡肺泡灌洗術。
[Abstract]:Objective: to investigate the clinical risk factors and outcome of mycoplasma pneumoniae pneumonia in children whose secretions blocked the airway.Methods: the clinical data of 130 children with mycoplasma pneumoniae pneumonia treated by bronchofibroscope lavage from September 2016 to January 2017 were analyzed retrospectively.According to the obstruction of airway with or without secretions under bronchoscope, the patients were divided into two groups: airway obstruction group and control group. The clinical manifestations, laboratory examination, changes under microscope, imaging features and outcome were compared between the two groups. Multivariate Logistic regression analysis was performed on MPP in the blockage group.ROC curves were plotted to find the critical value of the independent risk factors of MPP in children with secretions blocking the airway.The result is 1: 1.Sex and age: there was no significant difference in sex and age between the two groups.Imaging findings: the pulmonary imaging manifestations of the two groups were large slices of high density. The proportion of pulmonary atelectasis in the clogging group was higher than that in the control group (P 0.05), and 10% of the patients in the blockage group were complicated with pulmonary necrosis, including pleural effusion, involvement of lobes 鈮，

本文編號：1735511