目的 探讨支气管镜结合全身联合用药治疗儿童难治性肺炎支原体肺炎(RMPP)的临床疗效。方法 回顾性分析我院2018年3月至2020年3月的RMPP患儿临床资料,共205例,分为两组,其中气管镜组114例与对照组91例(未行支气管镜)。比较两组患儿一般资料、影像学检查、发热天数、住院天数、肺外并发症、实验室检查结果及全身联合用药使用情况。结果 ①气管镜检查治疗后患儿咳嗽发热等临床症状明显改善,住院天数(t= -2.514,P=0.013)及退热天数(t= -4.774,P=0.000)较对照组缩短。② 两组患者均常规使用大环内酯类抗生素,气管镜组较对照组联合糖皮质激素及丙种球蛋白使用率较对照组低[46(40.4)vs58(63.7)](X_²=11.072 _^a ,P=0.001)。与对照组比较,气管镜组联合使用糖皮质激素减少(X_²=10.454_^a,P=0.015)、联合使用免疫球蛋白减少(X_²=10.395_^a,P=0.001)。 ③ 治疗后复查生化指标,气管镜组较对照组CRP、LDH 、IgE检查指标均下降,CRP(t= -1.901,P=0.036)、LDH(t= -0.473,P=0.025)、IgE(t= -1.400,P=0.042)。结论 支气管镜对于治疗难治性支原体肺炎治疗起关键作用,支气管镜联合糖皮质激素及丙种球蛋白治疗比以往单一依靠药物治疗疗效肯定,能够促进疾病康复。

Objective To investigate the clinical effect of bronchoscopy combined with systemic therapy on children with refractory mycoplasma pneumonia (RMPP).Methods Analyzed the 205 children with RMPP from March 2018 to March 2020 in The Maternal and Child Health Hospital of Inner Mongolia Autonomous Region.The patients were divided into the bronchoscopy group (114 cases) and the control group (91 cases) according to whether do bronchoscopy.The general information, imaging examination, fever days, hospitalization days, extrapulmonary complications, laboratory examination results and drug use were compared between the two groups..Results①The clinical symptoms were significantly improved,There was statistical difference between the two groups in hospital days (t= -2.514,P=0.013) and antipyretic days (t=-4.774,P=0.000).②Both groups were routinely treated with macrolide antibiotics, and the utilization rate of the tracheal mirror group was lower than that of the control group (46 (40.4) vS58 (63.7) (X2= 11.072^a, P=0.001).Compared with the control group, glucocorticoids (X²=10.454 A, P=0.015) and immunoglobulin (X²=10.395^a, P=0.001)were reduced in the tracheal microscope group.③After treatment, CRP, LDH and IgE in tracheal microscope group were decreased compared with the control group, CRP (T = -1.901, P=0.036), LDH (T = -0.473, P=0.025) and IgE (T = -1.400, P=0.042).Conclusions Bronchoscopy plays a key role in the treatment of RMPP. The bronchoscopy combined with glucocorticoid and gamma globulin is more effective than the single drug therapy and can promote the recovery of the disease.

内蒙古自治区卫生计生科研计划项目(201702032)