本文選題：肺炎支原體肺炎 + 發(fā)病機(jī)制�。� 參考：《吉林大學(xué)》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(xiǎn)因素及轉(zhuǎn)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(shù)的肺炎支原體肺炎(MPP)患兒的臨床資料,根據(jù)支氣管鏡下有無(wú)分泌物堵塞氣道分為氣道堵塞組與對(duì)照組,對(duì)比兩組患兒的臨床表現(xiàn)、實(shí)驗(yàn)室檢查、鏡下改變、影像學(xué)特征及轉(zhuǎn)歸情況,對(duì)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(dú)立危險(xiǎn)因素的臨界值。結(jié)果:1.性別和年齡:兩組在性別、年齡方面差異無(wú)統(tǒng)計(jì)學(xué)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(duì)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?qū)嵰舯壤?56.7%比14.3%,P0.05)均高于對(duì)照組。3.實(shí)驗(yàn)室檢查:堵塞組外周血白細(xì)胞總數(shù)(9.4±3.7比8.2±2.9,P0.05)、中性粒細(xì)胞百分比(69.8±11.2比62.3±11.9,P0.05)、C反應(yīng)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(duì)照組。4.影像學(xué)表現(xiàn):兩組患兒肺部影像學(xué)均表現(xiàn)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(duì)照組(P0.05),堵塞組10%患兒合并肺壞死,對(duì)照組未見(jiàn)肺組織壞死。5.纖維支氣管鏡下表現(xiàn)及痰栓病理:堵塞組纖維支氣管鏡下均可見(jiàn)痰栓堵塞氣道,以右上肺、左下肺為主,其中3例可見(jiàn)樹(shù)枝樣痰栓,5例可見(jiàn)支氣管閉塞,對(duì)照組鏡下氣道內(nèi)可見(jiàn)絮狀漂浮物,未見(jiàn)支氣管閉塞。3例樹(shù)枝樣痰栓病理均為炎性壞死組織,可見(jiàn)纖維素、中等量中性粒細(xì)胞及淋巴細(xì)胞浸潤(rùn)。6.治療及轉(zhuǎn)歸:堵塞組住院時(shí)間高于對(duì)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(fù)正常,其中堵塞組22例,對(duì)照組22例。所有患兒均好轉(zhuǎn)出院。有效隨訪120例患兒至出院后1個(gè)月復(fù)查肺部影像學(xué),肺部炎癥完全吸收比例對(duì)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(duì)照組有67.1%患兒為RMPP。對(duì)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(dú)立危險(xiǎn)因素,其ROC曲線臨界值分別為9.5天、30.35mg/L、343.5U/L。結(jié)論:1.分泌物堵塞氣道的兒童MPP熱程、熱峰、住院時(shí)間、WBC、NE%、CRP、LDH、D-二聚體、合并呼吸音減弱、叩診濁音或?qū)嵰簟⑿厍环e液、肺不張、炎癥累及肺葉≥2的比例均明顯高于對(duì)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(xiǎn)因素,可作為預(yù)測(cè)指標(biāo)。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(shù)。
[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(hào)：1735511