The Research Of Glucocorticoid Therapy On Refractory Mycoplasma Pneumoniae Pneumonia In 87 Children

ObjectiveTo promote early clinical diagnosis of refractory mycoplasma pneumoniae pneumonia(RMPP) through analysising the features of clinical 、 laboratory and radiography of RMPP in children. To evaluate the values of glucocorticoid in the treatment of RMPP.MethodsCollected the patients with Mycoplasma pneumoniae pneumonia(MPP) who were hospitalized in the respiratory ward of Dalian Children’s Hospital from March 2012 to February 2014, 87 cases who were diagnosed as RMPP and fitted exclusion criteria were randomly divided into 2 groups—“research group” and “ control group”. 46 patients of “research group” were added methylprednisolone 2mg/(kg·d), iv drop for 3days based on conventional antibiotic and symptomatic therapy, 41 patients of “control group” were only accepted the same antibiotic and symptomatic therapy. The differences of 2 groups in clinical effect, extrapulmonary manifestations, degree of radiographic improvement, inpatient days, inpatient costs, security were compared.Results1. The average age of RMPP in 87 children was(6.0±2.6) years old, most common symptoms were high-grade fever(89.7%) and spasm cough(94.3%).The clinical signs of the lungs were uncommon accounting for 19.5% at the earlystage of the disease(<7d),then pulmonary rales were accounting for 93.1% in the process of treatment. 69cases(79.3%) had been accompanied with the extrapulmonary events, but the extrapulmonary events were not severe and had a good outcome. Most of RMPP patients had a high CRP(80.4%), average(25.1±17.3)mg/L.2. The most common radiographic manifestation was large lobe consolidation with high density(94.3%), Lesions located in single lungs was majority, up to 48cases(55.2%), the right lung was common. Each lobe might be impaired, the middle and lower lobe of right, the lingular and lower lobe of left were majority.3. Compared with “research group” and “control group”, the clinical indexes of defervescing days, remission duration of spasm cough, extrapulmonary manifestations,hospitalized days, inpatient costs, the former one was significantly better than the latter one(P<0.01). Most targets of radiographic improvement, the former one was significantly better than the latter one(P<0.01). No serious adverse events happened in“research group”, two cases have slight reactions; No statistical difference between 2groups with the number of infections within six months after discharge(P>0.05).4. 46 cases of “research group” were added methylprednisolone 2mg/(kg·d), iv drop for 3 days, 4 cases(8.7%) still had a fever, the radiographic expression had no improvement. All of 4 cases got a normal temperature and great radiographic improvement by prolonging course of glucocorticoid. A case accompanied with Steven Johnson symptom was added methylprednisolone 10mg/(kg·d) on account of severe mucous lesion, and got conspicuous remission after iv drop for 3 days.Conclusions1. Glucocorticoid can significantly shorten course of fever and spasm cough, reduce inpatient days, and lower inpatient costs of RMPP.2. Glucocorticoid can significantly promote radiographic improvement of RMPP,reduce inflammation, prevent the occurrence of pulmonary complications, and get good security.3. Using glucocorticoid for 3 days of common dose was effective to most of patients with RMPP, but unconspicuous to a few of severe cases. Increasing dose or prolonging course could get satisfying effect.