儿童肺炎支原体肺炎合并肺不张发病率及预后研究

探讨肺炎支原体肺炎合并肺不张患儿转归、应用纤维支气管镜灌洗治疗的时机及肺炎支原体肺炎后闭塞性细支气管炎的发病率。方法　回顾分析北京儿童医院2006年5月至2007年5月期间1166例住院治疗的肺炎支原体肺炎患儿临床资料，其中117例合并肺不张，出院后1.0～1.4年复查胸部高分辨CT（HRCT）及肺功能，接受随访者共36例。结果　（1）住院患儿中肺炎支原体肺炎合并肺不张的发病率为10.03%。（2）随访时，36例肺不张患儿胸部HRCT检测仍异常者23例，占随访患儿总数的63.89%。其中马赛克征9例次、支气管扩张12例次、支气管壁增厚11例次、血管细少2例次、小结节或树芽征3例次、黏液栓1例次、单侧透明肺1例次、条索状不张10例次。（3）纤维支气管镜灌洗治疗在病程 < 20 d与病程≥20 d两组比较，差异有统计学意义（P < 0.05）。（4）随访27例患儿肺功能，阻塞性通气功能障碍16例，混合性通气功能障碍，以阻塞为主1例。（5）在随访的36例肺不张患儿中，临床诊断闭塞性细支气管炎9例，占25%（9/36）。结论　肺炎支原体肺炎住院患儿合并肺不张的发病率10.03%；远期随访发现肺炎支原体肺炎后肺部后遗症主要为支气管扩张、闭塞性细支气管炎。早期行纤维支气管镜灌洗治疗，可能会减少肺部后遗症的发生；肺功能随访，提示肺炎支原体肺炎感染后部分患儿存在阻塞性通气功能障碍。

One-year follow-up study for mycoplasma pneumoniae pneumonia with pulmonary atelectasis complications.

Objective　To study the reversal of atelectasis during the recovery of mycoplasma pneumoniae pneumonia and determine the therapeutical time of fiber-optical bronchoscope-assisted washing treatment. To recognize the incidence of bronchiolitis obliterans. Methods 　Totally 109 cases of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication had been selected from 1166 patients who were treated in Beijing Pediatric Hospital between May 2006 and May 2007. After telephone appointments and parental authorizations， all pediatric patients were examined with HRCT and/or with pulmonary function after an interval of 1.0 to 1.4 years. Results　（1） The incidence of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication in hospitalized patients was 10.03%. （2） Reversal of atelectasis during recovery: one-year follow-up study showed that 23 patients have been identified with abnormal lung appearance by using HRCT imaging in 36 cases of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication， corresponding to a rate of 63.9%. The abnormalities were as follows： appearances of “mosaics” （9 cases）， bronchiectasis （12 cases）， thickened bronchial walls （11 cases）， decreased pulmonary vascularity （2 cases）， smaller tubercles and tree-in-bud patterns （3 cases）， mucus clots （1 case） ， unilateral hyperlucent lung （1 case） and rope-shaped atelectasis areas （10 cases）. （3） There was a significant difference in the therapeutically effect of fiber-optical bronchoscope-assisted washing treatment between the group within 20 days and more than 20 days of illness （P < 0.05）. （4） Analysis of the pulmonary functions in 27 cases showed that the pulmonary function was still abnormal with obstruction of ventilation function in 16 cases， complexed/mixed ventilation functional obstructions with blocking as primary obstacle in 1 case.（5） The incidence of bronchiolitis obliterans was 25% （9/36） in our study.Conclusion　The incidence of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication in hospitalized patients is 10.03%； the follow-up study shows that the sequelae of the mycoplasma pneumoniae pneumonia is mainly bronchiectasis and/or bronchitis obliterans； early application of the fiber-optical bronchoscope-assisted washing treatment may reduce the sequelae of the mycoplasma pneumoniae pneumonia； this one-year follow-up study also shows that the pulmonary function is still abnormal with obstruction of ventilation function in some patients.