分泌物堵塞气道的儿童肺炎支原体肺炎危险因素分析及转归

发布时间：2018-04-11 10:01

  本文选题：肺炎支原体肺炎 + 发病机制　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:探讨分泌物堵塞气道的儿童肺炎支原体肺炎的临床危险因素及转归。方法:回顾性分析2016年9月至2017年1月我院小儿呼吸科收治的130例行纤维支气管镜灌洗术的肺炎支原体肺炎(MPP)患儿的临床资料,根据支气管镜下有无分泌物堵塞气道分为气道堵塞组与对照组,对比两组患儿的临床表现、实验室检查、镜下改变、影像学特征及转归情况,对堵塞组MPP行多因素Logistic回归分析,并绘制ROC曲线,寻找分泌物堵塞气道的儿童MPP的各独立危险因素的临界值。结果:1.性别和年龄:两组在性别、年龄方面差异无统计学意义(P0.05),两组患儿发病年龄均以6岁以上为主。2.临床症状和体征:堵塞组与对照组相比较,热峰[39.8(39.5,40.0)比39.5(39.0,39.8),P0.05]、热程(11.3±3.1比7.8±2.4,P0.05]、呼吸音减弱的比例(80.0%比41.4%,P0.05)、叩诊浊音或实音比例(56.7%比14.3%,P0.05)均高于对照组。3.实验室检查:堵塞组外周血白细胞总数(9.4±3.7比8.2±2.9,P0.05)、中性粒细胞百分比(69.8±11.2比62.3±11.9,P0.05)、C反应蛋白(CRP,mg/L)[48.2(19.8,91.0)比12.4(7.1,25.4),P0.05]、乳酸脱氢酶(LDH,U/L)[466.5(371.5,639.0)比323.0(273.2,376.8),P0.05]、D-二聚体(ug/L)[1002.0(577.50,2042.0)比352.5(198.5,573.8),P0.05]均高于对照组。4.影像学表现:两组患儿肺部影像学均表现为大片状高密度影,堵塞组患儿合并胸腔积液、累及肺叶≥2、肺不张的比例均高于对照组(P0.05),堵塞组10%患儿合并肺坏死,对照组未见肺组织坏死。5.纤维支气管镜下表现及痰栓病理:堵塞组纤维支气管镜下均可见痰栓堵塞气道,以右上肺、左下肺为主,其中3例可见树枝样痰栓,5例可见支气管闭塞,对照组镜下气道内可见絮状漂浮物,未见支气管闭塞。3例树枝样痰栓病理均为炎性坏死组织,可见纤维素、中等量中性粒细胞及淋巴细胞浸润。6.治疗及转归:堵塞组住院时间高于对照组(13.5±3.8比8.5±3.2,P0.05)。两组患儿其中44例(33.8%)在第1次肺泡灌洗后1~3d体温恢复正常,其中堵塞组22例,对照组22例。所有患儿均好转出院。有效随访120例患儿至出院后1个月复查肺部影像学,肺部炎症完全吸收比例对照组高于堵塞组(84.4%比53.6%,P0.05)。7.堵塞组患儿均为难治性肺炎支原体肺炎(RMPP),对照组有67.1%患儿为RMPP。对有意义的单因素变量行Logistic回归分析,显示热程、CRP、LDH为分泌物堵塞气道的儿童MPP的独立危险因素,其ROC曲线临界值分别为9.5天、30.35mg/L、343.5U/L。结论:1.分泌物堵塞气道的儿童MPP热程、热峰、住院时间、WBC、NE%、CRP、LDH、D-二聚体、合并呼吸音减弱、叩诊浊音或实音、胸腔积液、肺不张、炎症累及肺叶≥2的比例均明显高于对照组,且堵塞组患儿均为难治性肺炎支原体肺炎。2.热程≥9.5天、CRP≥30.35mg/L、LDH≥343.5U/L是分泌物堵塞气道的儿童MPP危险因素,可作为预测指标。3.分泌物堵塞气道的儿童MPP肺部炎症重,病灶吸收慢,发生坏死性肺炎、闭塞性支气管炎的可能性大,建议积极行纤维支气管镜肺泡灌洗术。
[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，

本文编号：1735511