2 mg（/kg·d）甲泼尼龙静脉治疗3 d无效的小儿难治性肺炎支原体肺炎的临床特征分析

王楠1 ，孙荣2*

（1.西安一四一医院，陕西 西安，710089；2.泾阳县医院，陕西 咸阳,713700）

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摘要：

目的 探讨2 mg（/kg·d）甲泼尼龙静脉治疗3 d 无效的小儿难治性肺炎支原体肺炎（RMPP）的临床特征，为其治疗提供 参考。方法 回顾性分析2013 年8 月至2017 年8 月我院收治的275 例RMPP 患儿的临床资料，根据对初始2 mg（/kg·d）甲泼 尼龙静脉治疗3 d 的反应，分为有效组（210 例）和无效组（65 例）。分析两组的临床特征。结果 与有效组相比，无效组热程明 显延长，且以超高热为主（P<0.05）；无效组WBC、NEU%、CRP、SF、LDH、纤维蛋白原和混合感染率明显高于有效组（P<0.05），而L%显著低于有效组（P<0.05）；无效组发生支气管内膜粗糙、分泌物阻塞、亚支通气不良、支气管闭塞、内膜坏死及肺内外 并发症（除肺不张外）的比例明显高于有效组（P<0.05）；无效组患儿在增加激素剂量或合用丙种球蛋白治疗后症状好转。 结论 2 mg（/kg·d）甲泼尼龙静脉治疗3 d 无效的RMPP 患儿临床表现较治疗有效者更为严重，炎症反应更强烈。对于此类患 儿，可考虑加大激素剂量、延长疗程或联合丙种球蛋白治疗。

关键词：RMPP；小儿；甲泼尼龙

中图分类号：R725.6文献标志码：A文章编号：2096-1413(2018)04-0061-03

Clinical characteristics of RMPP in children with invalid treatment of 2 mg/(kg·d) methylprednisolone
WANG Nan 1, SUN Rong2 *
(1. Xi``an 141 Hospital, Xi``an 710089; 2. the Hospital of Jingyang County, Xianyang 713700, China)

ABSTRACT: Objective To investigate the clinical characteristics of RMPP in children with invalid treatment of 2 mg/(kg·d)
methylprednisolone, and to provide a reference for the treatment of RMPP. Methods The clinical data of 275 cases of children with RMPP in our hospital from August 2013 to August 2017 were analyzed retrospectively, and divided into valid group (210 cases) and invalid group (65 cases) according to the reaction of 2 mg/(kg·d) methylprednisolone treatment. The clinical characteristics of the two groups were analyzed. Results Compared with the valid group, the thermal course of the invalid group obviously prolonged, and the super high fever was the main symdrome (P<0.05). The level of WBC, NEU%, CRP, SF, LDH, fibrinogen and the rate of mixed infection in the invalid group were significantly higher than those in the valid group (P<0.05), while L% was significantly lower than that in the valid group (P<0.05). The proportion of bronchial membrane rough, secretion obstruction, poor sub ventilation, bronchial obstruction, intimal necrosis, intra and extra pulmonary complications (except atelectasis) in the invalid group were significantly higher than those in the valid group (P<0.05). The children in the invalid group improved after increasing the hormone doses or with gamma globulin treatment. Conclusion The clinical manifestations of RMPP in children with invalid treatment of 2 mg/(kg·d) methylprednisolone is more serious than treatment valid, the inflammatory reaction is more intense. For such children, may consider increasing hormone dose, extending treatment or gamma globulin treatment.
KEYWORDS: RMPP; children; methylprednisolone

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