| Background Mycoplasma pneumoniae is now one of the main pathogens of community acquired pneumonia, and in recent years the infection rate is rising. Because the clinial feature of mycoplasma pneumoniae pneumonia is variety, so it is easily to be misdiagnosed. Azithromycin is the often drug treatment of children infected mycoplasma pneumoniae pneumonia, but the clinical application is in a spider’s web of confusion,such as excessive intravenous application, inconformity of the course and so on, which lead to unnecessary injuries of children.Objectives To analyze clinical manifestations of MPP and the features of the children inflected MPP with extrapulmonary manifestations, to investigate the diagnosis, treatment plan and the course of intravenous azithromycin in the treatment of MPP, to explore the more safe, economic, effective treatment method.Methods120cases of children infected mycoplasma pneumonia in September2013-January2014in the pediatric of the first affiliated hospital of Xinxiang Medical University and the department of respiration in a pediatric hospital in Shanghai in treatment as the object of study,whose clinical manifestations, Imaging, laboratory examinations, methods of treatment were analyzed, were randomly divided into two groups, of which the single azithromycin intravenous application less than or equal to5days for the first treatment group, more than5days as the second treatment group.When the two groups combined with bacterial infection, they were treated with β-lactam antibiotics,or according to drug sensitivity results to adjust other antibiotics, and were given other symptomatic treatment measures according to clinical manifestation. During the treatment, the other drugs of the patients such as the cough-expectorant drugs were same. The azithromyc usages of two groups both are10mg/(kg.d), when the body temperature or the disease was controled, azithromycin was timely taken the intravenous usage to gastrointestinal application.If after7days’intravenous azithromycin treament,the patient’s station still. deteriorated, and the other infected and non-infected factors are excluded,it is considered refractory mycoplasmal pneumonia. After noticing the illness information to family members and getting agreement to give quinolones drugs such as ciprofloxacin or levofloxacin application. To observe the differences between two groups about the thermal process, extrapulmonary manifestations, physical signs of the lungs,the cough symptoms disappeared time,course of disease,duration of hospitalization and so on.Some cases with single pulmonary consolidation or atelectasis were treated by fiberoptic bronchoscopy to understand the difference to the simple drug treatment of MPP cases.Results1.In this study,69cases of boys,51cases of girls, the rates were42.07%and46.36%of boys and girls in patients with bronchial pneumonia at the same period, the difference had no statistical significance (P>0.05);26cases of infant period,54cases of pre-school children, and55cases of school children,the rates of which were20.47%,58.70%,72.73%of different age of hospitalized children at the same period,the incidence of the pre-school and school children was significantly higher than the infant period on the age factor,the difference was statistically significant (P<0.05).2.The main clinical symptoms of mycoplasma neumoniae pneumonia were fever about110cases (91.7%), cough about119(99%) cases,of which96(80%) cases with phlegm cough,23(19%) cases with dry cough,16(13.3%) cases with tachypnoea, or (and) wheezing.The moist rales in lungs may be heard of79(65.8%) cases, of which there were30(25%) cases with wheezing, there was no rale in pulmonary of29(24.2%) cases. White blood cell count was normal of65%, increased of26.7%, about 8.3%the count decreased, C-reactive protein in the serum was normal of35.8%,64.2%increased at different degree.The chest X-ray of54(45%) cases showed patchy exudation or patchy opacities,which is the most common,25(20.8%) cases showed large high density real variable, unilateral lesions of51.7%, more than48.3%bilateral lesions, the right middle lower lung or left lower lung lesion was the most common,the difference had no statistical significance (P>0.05).21(17.5%) cases underwent pulmonary function test,of which3(2.5%) cases were normal,6(5%) cases with mildly to moderately obstructive lesions,6cases (5%) with mildly to severely restrictive disease,6(5%) cases of airway resistance increased.18(15%) underwent fiberoptic bronchoscopy test,it could be seen that bronchial mucosa of the lesions showed congestion and edema, more or less sticky secretions from attachment, and the bronchial dysplasia and the proliferation of granulation tissue in the wall of the trachea.3.In this study,49cases associated with extrapulmonary manifestations,23cases (46.93%) of boys, and26cases (53.06%) of girls, the difference of incidence was no statistically significant (P>0.05).16cases of infant period,21cases of pre-school children, and12cases of school children respectively accounted for61.5%,38.9%,30%in each age group, the incidence of infant period was significantly higher than pre-school and school children, and the difference was statistically significant (P<0.05). To observe the children with extrapulmonary manifestations that the average thermal process was10.31±6.13days,and the time of pulmonary rales disappearance was14.69±10days,which were both longer than that of7.59±5.31days and7.70±6.18days of simple MPP group, the difference was statistically significant (P<0.05).But the differences between two groups of cough symptom continuance time which was respectively20.27±8.47days and17.90±8.10days, and the average hospitalization which was10.87±3.54days and11.04±5.70days were no statistical significance.(P>0.05). 4.In infant group there was7(27%) cases with hyperpyrexia (more than39℃),23(88%) cases with phlegm cough,3(12%) cases with dry cough,8(31%) cases with wheezing,23(88%) cases with moist rales and18(69%) cases with wheezing in lungs. In pre-school children group there was30(56%) cases with hyperpyrexia,44(81%) cases with phlegm cough,9(17%) cases with dry cough,1(2%) cases with wheezing,38(70%) cases with moist rales and8(15%) cases with wheezing in lungs. In school children group there was24(60%) cases with hyperpyrexia,29(72.5%) cases with phlegm cough,11(27.5%) cases with dry cough,1case without cough,no case with wheezing,18(45%) cases with moist rales and4(10%) cases with wheezing in lungs. The proportion of hyperpyrexia in infant group was higher than that of school and pre-school children group, the difference was statistically significant (P<0.05). The cough expression such as phlegm cough,dry cough and so on was different among three groups, but the difference of proportion was not statistically significant (P>0.05); the ratio of wheezing in infant group was significantly higher than that of pre-school and school children group, the difference was statistically significant (P<0.05).5. The average thermal process and the pulmonary rales disappearance time of the first treatment group were respectively3.08±2.94days and6.75±4.71days,compared with that of the second treatment group which were2.94±3.05days and5.12±5.13days,the differences were no statistical significance (P>0.05), but the time of cough symptom continuance and the average hospitalization of the first treatment group was respectively9.98±5.18days and12.23±6.08days,which were both longer than that of8.34±3.78days and9.27±3.71days of the second treatment group, the difference was statistically significant (P<0.05). The second group were divided into three groups according to the intravenous administration course of azithromycin,6days’ group,7days’ group and8days’group, there was no significant difference in the effect of clinical treatment in the there groups (P>0.05).The differences of clinical efficacy between the first treatment group and6days’group(or8days’group) were no statistical significance.(P>0.05); the average thermal process of the7days’group, which compared with the first treatment group the difference was no statistical significance.(P>0.05),but the time of cough symptom continuance, pulmonary rales disappearance and the average hospitalization were respectively8.13±2.10days,4.31±3.83days and9.04±2.19days, compared with the first treatment group the differences were all statistical significance (P<0.05).6.The average thermal process of the group combined with application of fiberoptic bronchoscope was2.94±3.17days,the time of cough symptom continuance was8.56±1.72days, the time of pulmonary rales disappearance was7.33±2.59days,and the average hospitalization was10.28±3.63days,compared with that3.01±2.99days,9.11±4.77days,5.56±5.21days and10.67±5.26days of the simple drug treatment group in treating mycoplasma pneumoniae pneumonia,the differences were no statistically significant (P>0.05).7. Observation of adverse reaction There was respectively1case with a skin rash relevant to the drug in the first treatment group and the second treatment group, but it had no significant difference (P=1.000),and there were no gastrointestinal reactions such as vomiting, abdominal pain, injection site pain, liver damage and so on,all of which associated with drugs in two groups.Conclusion1. The incidence of MPP is higher in pre-school and school children, also there’s a certain incidence in the infant period.2. The incidence of extrapulmonary manifestations is higher in the infant period than the pre-school and school children.The thermal process and pulmonary rale disappearance time were longer in MPP with extrapulmonary manifestations group,but it could not prolong the course of disease.3. The proportion of hyperpyrexia of pre-school and school children was significantly higher than that of infant group, but the proportion of wheezing of infant group was significantly higher than that of pre-school and school children group. 4. The treatment of MPP combined with fiberoptic bronchoscopy could not shorten the course of disease and hospitalization.5. The7days’ therapy of the intravenous azithromycin could reduce the cough time, shorten the hospitalization date, and the therapy is safe,the adverse drug reactions had no statistical significance. |
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