44例儿童难治性肺炎支原体肺炎的并发症及胸部CT特点

目的评价临床并发症和早期胸部CT检查在儿童难治性肺炎支原体肺炎中的鉴别诊断价值。方法回顾性收集2017年10月~2018年1月本院收治的44例肺炎支原体肺炎患儿的临床资料和影像学结果,所有患儿按2013版儿童社区获得性肺炎管理指南分为普通组和难治组,分析常见并发症(低氧血症、呼吸衰竭、血清电解质紊乱、肝功能异常)及常见CT影像征象(斑片状影、实变影、血管增粗影、支气管缩窄、胸腔积液、淋巴结增大)在普通组和难治组之间的差异。结果通过对普通组与难治组患儿进行比较,本研究发现难治组患儿入院时长及大环内酯类抗生素使用时间明显高于普通组患儿,差异具有统计学意义(P0.05);并发症情况显示难治组中肝功能异常者显著多于普通组,其余3项并发症虽难治组中例数多于普通组,但统计学上无显著性差异(P0.05);口咽拭子病原学结果显示难治组患儿合并其他病原体感染的比例显著高于普通组;难治组患儿的胸部CT在实变影、支气管缩窄及胸腔积液的发生情况方面显著高于普通组。结论肝功能异常等并发症和典型的间质水肿影像在难治性肺炎支原体肺炎中具有鉴别应用价值,临床工作中可进行参考。

The complications and chest CT features of 44 children with refractory mycoplasma pneumoniae pneumonia

Objective To evaluate the differential diagnostic value of clinical complications and early chest CT in children with refractory differential diagnostic value. Methods The clinical data and imaging findings of 44 children with mycoplasma pneumoniae pneumonia admitted in our hospital from October 2017 to January 2018 were retrospectively collected. All children were divided into general group and refractory group according to the 2013 version of the guidelines for community-acquired pneumonia in children. The differences in common complications (hypoxemia, respiratory failure, serum electrolyte imbalance, abnormal liver function) and common CT imaging signs(plaque patch shadow,consolidation shadow, blood vessel thickening shadow, bronchial constriction, pleural effusion, lymph node enlargement between the general group and the refractory group. Results By comparing the general group with the refractory group,the study found that the length of hospital admission and the use of macrolide antibiotics in the refractory group were significantly higher than those in the general group, and the difference was statistically significant(P<0.05); The patients with abnormal hepatic function in the refractory group were significantly more than those in the general group, and the difference was stitistically significant. The complications showed that the abnormal liver function in the refractory group was significantly more than that in the general group, and the remaining 3 complications in the refractory group were more than those in the general group, but there was no statistically significant difference(P>0.05). The etiological results of the oropharyngeal swab showed that the proportion of children infected with other pathogens in the treatment group was significantly higher than that of the general group. And the occurrence of consolidation, bronchial constriction, and pleural effusion in the chest CTof the refractory group was significantly higher than that of the general group. Conclusion The complications such as liver function abnormality and typical interstitial edema imaging have differential application value in refractory pneumonia of mycoplasma pneumoniae, which can be referenced in clinical work.