中国药物警戒 ›› 2023, Vol. 20 ›› Issue (12): 1391-1395.
DOI: 10.19803/j.1672-8629.20230739

• 安全与合理用药 • 上一篇    下一篇

儿童肺炎支原体肺炎的临床诊疗及相关药物合理使用

贾兆广1, 徐文帅2, 季丽娜2, 王琳琳2, 赵丽娜2, 赵景全2, 牟向东2*   

  1. 1青岛市第八人民医院急诊医学部，山东 青岛200100;
    2清华大学附属北京清华长庚医院呼吸与危重症医学科，清华大学医学中心，北京 102218
  • 收稿日期:2023-11-23 出版日期:2023-12-15 发布日期:2023-12-15
  • 通讯作者: *牟向东,男,博士,教授·博导,临床肺部疾病研究。E-mail: muxiangdong@medmail.com.cn
  • 作者简介:贾兆广,男,硕士,副主任医师,慢性阻塞性肺病与肺炎研究。
  • 基金资助:
    北京市临床重点专科项目（XKB2022B1002）

Diagnosis and treatment of mycoplasma pneumoniae pneumonia in children and rational administration of related drugs

JIA Zhaoguang1, XU Wenshuai2, JI Li’na2, WANG Linlin2, ZHAO Li’na2, ZHAO Jingquan2, MU Xiangdong2,*   

  1. 1Department of Emergency Medicine of Qingdao Eighth People’s Hospitall, Qingdao Shandong 200100, China;
    2Department of Critical Care Medicine of Beijing Tsinghua Changgung Hospital Beijing, 102218, China
  • Received:2023-11-23 Online:2023-12-15 Published:2023-12-15

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摘要： 目的 研究儿童肺炎支原体肺炎（MPP）临床诊疗方法及相关药品的安全合理使用。方法 从流行病学、临床表现、影像学表现、治疗方法及其副反应等方面展开论述。结果 自2023年秋季以来,我国儿童MPP明显增多,临床主要表现为发热、咳嗽等症状,一般为轻症,预后较好;少数可发展为重症。对于儿童MPP,大环内酯类宜作为首选药,但国内耐药比较普遍;四环素类药物可替代之,且耐药少见,但要求用于8岁及以上儿童;喹诺酮类药物18岁以下均属超说明书用药,非必要不用;重症MPP（SMPP）还可短期应用糖皮质激素对症抗炎治疗。对于合并大面积肺实变、肺不张、塑形性支气管炎等并发症的患儿,宜尽早进行支气管肺泡灌洗治疗,并建议在全麻下实施,可明显提高疗效和改善预后。结论 对于轻症MPP,应用抗支原体药物及对症治疗,一般会取得较好的疗效;对于SMPP,在有效抗感染的基础上,可短期加用糖皮质激素治疗,必要时行支气管镜肺泡灌洗治疗,可明显提高疗效和改善预后。

关键词: 肺炎支原体肺炎, 儿童, 重症, 大环内酯类, 新型四环素类, 呼吸喹诺酮类, 糖皮质激素, 支气管肺泡灌洗

Abstract: Objective To study the clinical diagnosis and treatment of Mycoplasma pneumoniae pneumonia (MPP) in children and the safe and reasonable use of related drugs. Methods Review from the perspectives of epidemiology, clinical and imaging manifestations, treatment methods, and side effects. Results Since the autumn of 2023, there has been a significant increase in MPP in children in China, with clinical manifestations such as fever and cough, which are generally mild and have a good prognosis; A few may develop into severe illness. For children with MPP, macrolides should be the preferred drug, but drug resistance is relatively common in China; Tetracyclines can be substituted and resistance is rare, but they are required for children more than 8 years; Quinolone drugs under the age of 18 belong to the category of over-the-counter medication and are not necessary; Severe MPP can also receive short-term symptomatic anti-inflammatory treatment with glucocorticoids. For children with complications such as extensive lung consolidation, atelectasis, and plastic bronchitis, early bronchoalveolar lavage treatment is recommended, and it is recommended to implement it under general anesthesia, which can significantly improve the outcome and prognosis. Conclusion For mild MPP, the application of anti-mycoplasma drugs and symptomatic treatment generally achieves good therapeutic effects; For severe MPP, on the basis of effective anti-infection, short-term treatment with glucocorticoids can be added, and if necessary, bronchoscopic alveolar lavage can significantly improve the outcome and prognosis.

Key words: mycoplasma pneumoniae pneumonia, children, severe cases, macrolides, novel tetracyclines, respiratory quinolones, glucocorticoids, bronchoalveolar lavage

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