早期与晚期行支气管镜术RMPP患儿临床特征及治疗效果比较
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摘要
目的比较早期与晚期行支气管镜术难治性肺炎支原体肺炎(RMPP)患儿临床特征、支气管镜特点及支气管镜治疗效果。方法采用回顾性病例研究的方法,收集安徽医科大学附属省儿童医院收治的105例行支气管镜术治疗RMPP患儿的临床资料,根据患者病程和手术时机的不同,分为早期组(病程<10 d)66例和晚期组(病程≥10 d)39例。比较2组患儿临床特征、支气管镜特点及支气管镜治疗效果的差异。结果 2组患儿胸腔积液、肺实变及肺不张等肺部影像学特征差异无统计学意义(P>0.05);与晚期组相比,早期组发热时间明显缩短(P<0.01)。2组患儿支气管镜下均出现气道黏液分泌物增多、黏液栓阻塞、黏膜腺体小结节样突起、黏膜充血水肿、黏膜纵行皱褶、黏膜坏死溃疡、黏膜糜烂、黏液栓等特点;晚期组黏膜病变较早期组更为显著,可见黏膜苍白增厚、黏膜肉芽组织增生、管腔变形狭窄、支气管开口和管腔炎性狭窄。2组患儿支气管镜肺泡灌洗次数存在明显差异(P<0.05)。相比晚期组,早期组住院天数和肺部影像学好转时间明显减少(P<0.01)。结论在发病时间<10 d内行早期支气管镜术可有效改善RMPP患儿的病情程度,缩短病程,减缓病情进展,同时可尽早促进患儿肺复张和肺实质吸收,有助于改善患儿的预后状况。
Objective To compare the clinical features, bronchoscopic characteristics and therapeutic effects of bronchoscopy in children with refractory Mycoplasma pneumonia(RMPP) who underwent early and late bronchoscopy. Methods A retrospective case study was conducted to collect the clinical data of 105 children with RMPP treated by bronchoscopy in our hospital. They were divided into early group(course<10 d) with 66 cases and late group(course≥10 d) with 39 cases according to the course of disease and the timing of operation. The clinical characteristics, bronchoscopic characteristics and therapeutic effects of bronchoscope were compared between the two groups. Results There was no significant difference between the two groups in lung imaging features such as pleural effusion, pulmonary consolidation and atelectasis(P>0.05), and fever time in the early group was significantly shorter than that in the late group(P<0.01). Under bronchoscopy, airway mucus secretion increased, mucus embolism obstructed, small nodular processes of mucosal glands, congestion and edema of mucosa, longitudinal folds of mucosa, necrotic ulcer of mucosa, erosion of mucosa and mucus embolism were observed in both groups. Mucosal lesions in the late group were more significant than those in the early group. Mucosal pale and thickening, mucosal granulation tissue hyperplasia, lumen deformation and stenosis, and inflammatory stenosis of the bronchial opening and lumen were observed. There was significant difference in the times of bronchoscopic alveolar lavage between the two groups(P<0.05). Compared with the late group, the hospitalization days and the improvement time of lung imaging in the early group were significantly reduced(P<0.01). Conclusion Early bronchoscopy within 10 days of onset can effectively improve the severity of RMPP, shorten the course of the disease, slow down the progress of the disease, promote lung recruitment and pulmonary parenchymal absorption as soon as possible, which is helpful to improve the prognosis of children with RMPP.
Objective To compare the clinical features, bronchoscopic characteristics and therapeutic effects of bronchoscopy in children with refractory Mycoplasma pneumonia(RMPP) who underwent early and late bronchoscopy. Methods A retrospective case study was conducted to collect the clinical data of 105 children with RMPP treated by bronchoscopy in our hospital. They were divided into early group(course<10 d) with 66 cases and late group(course≥10 d) with 39 cases according to the course of disease and the timing of operation. The clinical characteristics, bronchoscopic characteristics and therapeutic effects of bronchoscope were compared between the two groups. Results There was no significant difference between the two groups in lung imaging features such as pleural effusion, pulmonary consolidation and atelectasis(P>0.05), and fever time in the early group was significantly shorter than that in the late group(P<0.01). Under bronchoscopy, airway mucus secretion increased, mucus embolism obstructed, small nodular processes of mucosal glands, congestion and edema of mucosa, longitudinal folds of mucosa, necrotic ulcer of mucosa, erosion of mucosa and mucus embolism were observed in both groups. Mucosal lesions in the late group were more significant than those in the early group. Mucosal pale and thickening, mucosal granulation tissue hyperplasia, lumen deformation and stenosis, and inflammatory stenosis of the bronchial opening and lumen were observed. There was significant difference in the times of bronchoscopic alveolar lavage between the two groups(P<0.05). Compared with the late group, the hospitalization days and the improvement time of lung imaging in the early group were significantly reduced(P<0.01). Conclusion Early bronchoscopy within 10 days of onset can effectively improve the severity of RMPP, shorten the course of the disease, slow down the progress of the disease, promote lung recruitment and pulmonary parenchymal absorption as soon as possible, which is helpful to improve the prognosis of children with RMPP.
引文
[1] 罗琼,茹凉,杨杰,等.儿童肺炎支原体肺炎的临床和实验室检查特征分析[J].新疆医科大学学报,2012,35(3):355-359.
[2] LING Z,LIU X,GUO S,et al.Role of probiotics in Mycoplasma pneumoniae pneumonia in children:A short-term pilot project[J].Front Microbiol,2019,9(1):3261.
[3] IZUMIKAWA K.Clinical features of severe or fatal Mycoplasma pneumoniae pneumonia[J].Front Microbiol,2016,7(1):800.
[4] XU Q,ZHANG L,HAO C,et al.Prediction of bronchial mucus plugs formation in patients with refractory Mycoplasma pneumoniae pneumonia[J].J Trop Pediatr,2017,63(2):148-154.
[5] SHAN L S,LIU X,KANG X Y,et al.Effects of methylprednisolone or immunoglobulin when added to standard treatment with intravenous azithromycin for refractory Mycoplasma pneumoniae pneumonia in children[J].World J Pediatr,2017,13(4):321-327.
[6] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7] 马颖,张峰波,季萍,等.新疆非典型呼吸道感染病原体检测结果分析[J].新疆医科大学学报,2016,39(1):87-89.
[8] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):856-862.
[9] LEE H,YUN K W,LEE H J,et al.Antimicrobial therapy of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J].Expert Rev Anti Infect Ther,2018,16(1):23-34.
[10] JIANG W,QIAN L,LIANG H,et al.Relationships between the varied ciliated respiratory epithelium abnormalities and severity of Mycoplasma pneumoniae pneumonia[J].Scand J Infect Dis,2014,46(7):486-492.
[11] 楚文英,徐慧,高淑青,等.高敏C-反应蛋白与免疫功能检测在肺炎支原体肺炎中的意义[J].临床儿科杂志,2014,32(5):456-458.
[12] 卢志威,杨军,王缨,等.肺炎支原体相关性噬血细胞综合征三例并文献复习[J].中华儿科杂志,2014,52(10):792-796.
[13] 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组,中国医师协会儿科医师分会内镜专业委员会,中国医师协会内镜医师分会儿科呼吸内镜专业委员会,等.中国儿科可弯曲支气管镜术指南(2018年版)[J].中华实用儿科临床杂志,2018,33(13):983-989.
[14] WANG L,LU S,FENG Z,et al.The early examination of combined serum and imaging data under flexible fiberoptic bronchoscopy as a novel predictor for refractory Mycoplasma pneumoniae pneumonia diagnosis[J].Medicine (Baltimore),2017,96(50):e9364.
[2] LING Z,LIU X,GUO S,et al.Role of probiotics in Mycoplasma pneumoniae pneumonia in children:A short-term pilot project[J].Front Microbiol,2019,9(1):3261.
[3] IZUMIKAWA K.Clinical features of severe or fatal Mycoplasma pneumoniae pneumonia[J].Front Microbiol,2016,7(1):800.
[4] XU Q,ZHANG L,HAO C,et al.Prediction of bronchial mucus plugs formation in patients with refractory Mycoplasma pneumoniae pneumonia[J].J Trop Pediatr,2017,63(2):148-154.
[5] SHAN L S,LIU X,KANG X Y,et al.Effects of methylprednisolone or immunoglobulin when added to standard treatment with intravenous azithromycin for refractory Mycoplasma pneumoniae pneumonia in children[J].World J Pediatr,2017,13(4):321-327.
[6] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7] 马颖,张峰波,季萍,等.新疆非典型呼吸道感染病原体检测结果分析[J].新疆医科大学学报,2016,39(1):87-89.
[8] 中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):856-862.
[9] LEE H,YUN K W,LEE H J,et al.Antimicrobial therapy of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J].Expert Rev Anti Infect Ther,2018,16(1):23-34.
[10] JIANG W,QIAN L,LIANG H,et al.Relationships between the varied ciliated respiratory epithelium abnormalities and severity of Mycoplasma pneumoniae pneumonia[J].Scand J Infect Dis,2014,46(7):486-492.
[11] 楚文英,徐慧,高淑青,等.高敏C-反应蛋白与免疫功能检测在肺炎支原体肺炎中的意义[J].临床儿科杂志,2014,32(5):456-458.
[12] 卢志威,杨军,王缨,等.肺炎支原体相关性噬血细胞综合征三例并文献复习[J].中华儿科杂志,2014,52(10):792-796.
[13] 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组,中国医师协会儿科医师分会内镜专业委员会,中国医师协会内镜医师分会儿科呼吸内镜专业委员会,等.中国儿科可弯曲支气管镜术指南(2018年版)[J].中华实用儿科临床杂志,2018,33(13):983-989.
[14] WANG L,LU S,FENG Z,et al.The early examination of combined serum and imaging data under flexible fiberoptic bronchoscopy as a novel predictor for refractory Mycoplasma pneumoniae pneumonia diagnosis[J].Medicine (Baltimore),2017,96(50):e9364.