摘要
例1,男,7岁,主因“咳嗽7 d,发热5 d”入院。肺炎支原体抗体强阳性,胸部CT提示右下肺不张,右侧胸腔积液,支气管镜提示右下叶前、外基底段塑型性痰栓,颅脑磁共振:左侧小脑半球及桥脑梗死,右侧小脑半球腔隙性脑梗死。病程第10天突发意识障碍,经机械通气、抗感染、抗炎、抗凝、降颅压、营养脑神经等治疗,3个月后神志转清,康复好转。例2,男,5岁6个月,主因“咳嗽1月余,发热6 d”入院。肺炎支原体抗体强阳性,胸部CT右肺下叶不张,右侧胸腔积液,支气管镜提示右下外基底段塑型性痰栓,颅脑磁共振:脑桥、双侧丘脑、双侧小脑半球及蚓部、双侧海马、枕叶及左侧颞叶脑梗死。病程第11日突发抽搐,意识丧失,呼吸衰竭,经机械通气、血浆置换、抗感染、抗炎、抗凝、降颅压等治疗后离氧能自主呼吸,仍处昏迷状态,继续后续康复。重症肺炎支原体肺炎患儿以大片肺不张为首发表现,病程中有可能发生脑梗死,应早期识别,及时干预,改善预后。
Case 1:male,7 years old,main cause included cough for 7 days,fever for 5 days;Mycoplasma pneumoniae was strongly positive;chest CT showed right lower atelectasis and right pleural effusion;bronchoscopy showed plastic sputum plug in right lower lobe and outer basal segment;craniocerebral magnetic resonance showed left cerebellar hemisphere and pontine infarction,lacunar infarction of the right cerebellum.On the 10th day of the disease,a sudden disturbance of consciousness occurred.After mechanical ventilation,anti-infection,anti-inflammatory,anticoagulation,intracranial blood pressure reduction,brain and nerve nutritional treatment,the patient mind cleared and recovered well after 3 months.Case 2:male,5 years and 6 months,main cause included cough for more than 1 month and fever for 6 days;Mycoplasma pneumoniae was strongly positive;chest CT showed right lower atelectasis and right pleural effusion;bronchoscopy showed plastic sputum plug in right lower lobe and outer basal segment;craniocerebral magnetic resonance showed pontine,bilateral thalamus,bilateral cerebellar hemispheres and vermis,bilateral hippocampus,occipital lobe and left temporal lobe cerebral infarction.On the 11th day of the disease,sudden convulsions,loss of consciousness,and respiratory failure occurred.After mechanical ventilation,plasmapheresis,anti-infection,anti-inflammatory,anticoagulation,and intracranial pressure reduction,the patient was allowed to breathe spontaneously,but still in a coma,and recovery continued.Children with severe mycoplasma pneumonia are firstly manifested as large atelectasis.Cerebral infarction may occur during the course of disease.Early identification and timely intervention should be performed to improve the prognosis.
作者
陈琼华
郑敬阳
陈添峰
曾丽娥
林春燕
林洁如
林扬升
尤玉婷
CHEN Qionghua;ZHENG Jingyang;CHEN Tianfeng;ZENG Li'e;LIN Chunyan;LIN Jieru;LIN Yangsheng;YOU Yuting(Department of Respiratory Medicine,Quanzhou Children's Hospital in Fujian,Quanzhou 362000,China;Department of Radiology,Quanzhou Children's Hospital in Fujian,Quanzhou 362000,China)
出处
《中国现代医生》
2020年第13期162-166,共5页
China Modern Doctor
基金
福建省泉州市卫生健康科研资助项目(泉卫办医政函〔2019〕3号)。
关键词
肺不张
肺炎支原体
脑梗死
儿童
Atelectasis
Mycoplasma pneumonia
Cerebral infarction
Children
