Abstract:

Objective    To analyse the treatment effects of bronchoscopy lavage treatment for RMPP，and to study the proper time to do the operation. Methods    A total of 76 cases，from June to December 2013，were enrolled in the retrospective study. According to the the course of the disease，there were divided into three groups，≤2 weeks，＞2～3 weeks and ＞3 weeks. The febrile period，duration of hospital stay，WBC，N%，L%，CRP，the chest radiography and the bronchoscopic findings were compared with each other. Results    The febrile period：≤2 weeks group it was 13.9±3.8； in ＞2～3 weeks group，14.1±5.0； in ＞3 weeks group，14.1±5.0； they all had significant difference between each other. The chest radiographic changes were divided into complete absorption，partial absorption and no change. Compare the chest radiography at the 7th day after operation， the ratio was 14.3%，5.4% and 0；85.7%，75.8% and 76.0%；0，18.9% and 24.0%. At one month，the ratio was 41.4%，26.3% and 11.3%；42.4%，65.7% and 75.1%；0，7.9% and 13.6%. According to the bronchoscopic findings we analysed，the airway mucosal or bronchial wall’s lesions in RMPP mainly were white mucosa covered，mucosal erosions and roughness. Lumen stenosis，dilator，obliteration and mucosa plug were seen more in the third group. Conclusion    In the treatment of RMPP children，earlier bronchoscopy therapy can help shorten the fever course and promote chest radiography improvement. The mycoplasma infection of long time could cause lumen stenosis，dilator，obliteration and mucosa plug.

Key words: refractory Mycoplasma peumoniae pneumonia, bronchoscope, child, bronchoscopic findings

摘要：

目的    探讨支气管肺泡灌洗术在难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia， RMPP）治疗中的作用及最佳治疗时机。方法　2013年6～12月在中国医科大学附属盛京医院确诊为RMPP的76例患儿，在不同病程时进行了支气管镜肺泡灌洗术。根据其行支气管镜术时病程分为：（1）≤2周组，（2）＞2～3周组，（3）＞3周组。比较分析3组患儿的总热程、肺CT好转情况、支气管镜下表现、实验室生化指标及住院天数。 结果　（1）总热程：病程≤2周组为（13.9±3.8） d， ＞2～3周组为（14.1±5.0） d，＞3周组为（20.0±8.4） d，３组比较，差异具有统计学意义。（2）肺CT改变：根据术后1周及1个月数据分析，3组患儿在术后1周复查肺CT，其完全吸收率分别为14.3%，5.4%，0；部分吸收率分别为85.7%，75.8%，76.0%；未改变率分别为0，18.9%，24.0%。1个月后复查肺CT，完全吸收率分别为41.4%，26.3%，11.3%；部分吸收率分别为71.4%，65.7%，75.1%；未改变率分别为0，7.9%，13.6%。（3）支气管镜下改变：对支气管镜下黏膜/支气管壁改变及管腔进行统计分析，可以发现RMPP患儿支气管镜下黏膜多表现为白色被膜覆盖、黏膜糜烂、黏膜粗糙改变；病程＞3周组，管腔扩张、管腔狭窄、管腔闭锁以及坏死物质栓塞明显高于其他2组。结论    在儿童RMPP治疗中，及早进行纤维支气管镜辅助治疗有助于缩短发热时间，促进肺CT好转。肺炎支原体感染时间越长，支气管壁及管腔出现管腔扩张、管腔狭窄、管腔闭锁以及坏死物质栓塞概率增大。

关键词: 难治性肺炎支原体肺炎, 支气管镜, 儿童, 镜下表现