High-risk factors and nursing strategies of plastic bronchitis in children Mycoplasma pneumoniae pneumonia
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摘要:
目的 在小儿肺炎支原体肺炎(MPP)发病率上升且其严重并发症塑型性支气管炎(PB)可致患儿通气障碍甚至危及生命的背景下，本研究通过回顾病历资料，识别小儿MPP并发PB的高危因素，以制定针对性的护理对策，为临床早期干预提供科学依据。 方法 采用回顾性分析方法，选取2021年5月—2024年5月于天津市儿童医院确诊为MPP的260例患儿为研究对象，根据是否并发PB将其分为并发组(42例)和未并发组(218例)。收集患儿的一般资料和临床特征等，采用单因素和多因素logistic回归分析研究可能导致MPP患儿PB发生的相关因素。 结果 单因素分析显示，与未并发组比较，并发组患儿热峰≥38.5 ℃、热程≥5 d、患有胸腔积液的比例及C反应蛋白(CRP)、乳酸脱氢酶(LDH)、降钙素原(PCT)、红细胞沉降率(ESR)、D-二聚体(D-D)水平更高(P＜0.05)。多因素logistic回归分析显示，热程≥5 d(OR=4.170，95% CI：1.778~9.783)、患有胸腔积液(OR=3.010，95% CI：1.186~7.637)、CRP≥20.13 mg/L(OR=2.389，95% CI：1.299~4.395)、LDH≥361.25 U/L(OR=2.462，95% CI：1.213~4.996)是影响MPP患儿PB发生的独立高危因素(P＜0.05)。 结论 MPP患儿的热程、胸腔积液、CRP、LDH与其并发PB密切相关。临床上应建立完善的监测体系，加强抗感染治疗强度并适当延长疗程，积极处理胸腔积液，密切观察患儿呼吸、咳嗽等症状变化，给予针对性呼吸道护理，以预防PB的发生与进展。 Abstract:Objective In the context of the increasing incidence of Mycoplasma pneumoniae pneumonia (MPP) and the thing that plastic bronchitis (PB) can cause ventilation disorders and even life-threatening in children, this study reviews the case data, identifies high-risk factors of PB in MPP children and formulates targeted nursing strategies to provide a scientific basis for early clinical intervention. Methods In the retrospective study, 260 children with MPP confirmed in Tianjin Children ' s Hospital were enrolled as the research objects between May 2021 and May 2024. According to the presence or absence of PB, they were divided into an occurrence group (n=42) and a non-occurrence group (n=218). The general data and clinical characteristics of children were collected. The possible influencing factors of PB in MPP children were analyzed using univariate and multivariate logistic regression analysis. Results Univariate analysis showed that compared with non-occurrence group, proportions of thermal spike ≥ 38.5 ℃, fever duration ≥ 5 d and pleural effusion, levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and D-dimer (D-D) were higher in occurrence group (P < 0.05). Multivariate logistic regression analysis showed that fever duration ≥5 d (OR=4.170, 95% CI: 1.778-9.783), pleural effusion (OR=3.010, 95% CI: 1.186-7.637), CRP ≥ 20.13 mg/L (OR=2.389, 95% CI: 1.299-4.395) and LDH ≥ 361.25 U/L (OR=2.462, 95% CI: 1.213-4.996) were independent high-risk factors of PB in MPP children (P < 0.05). Conclusion The fever duration, pleural effusion, CRP, and LDH are closely related to PB in MPP children. Clinically, it is necessary to establish a perfect monitoring system, strengthen anti-infection treatment intensity, appropriately prolong the course of treatment, actively treat pleural effusion, closely monitor changes in respiration, cough, and other symptoms, and take targeted respiratory nursing to prevent the occurrence and progression of PB. -
表 1 2组MPP患儿临床资料比较[例(%)]
Table 1. Comparison of general data and clinical characteristics between two groups of MPP children [cases (%)]
项目 并发组(n=42) 未并发组(n=218) χ2值 P值 年龄(岁) 2.580 0.108 ＜6 14(33.33) 102(46.79) ≥6 28(66.67) 116(53.21) 性别 1.158 0.282 男 28(66.67) 166(76.15) 女 14(33.33) 52(23.85) 发热 0.999a 有 42(100.00) 218(100.00) 无 0 0 热峰(℃) 8.775 0.003 ＜38.5 10(23.81) 106(48.62) ≥38.5 32(76.19) 112(51.38) 热程(d) 15.216 ＜0.001 ＜5 8(19.05) 113(51.83) ≥5 34(80.95) 105(48.17) 住院时间(d) 2.646 0.104 ＜7 13(30.95) 97(44.50) ≥7 29(69.05) 121(55.50) 咳嗽 0.999a 有 42(100.00) 218(100.00) 无 0 0 呼吸困难 1.147 0.284 有 14(33.33) 92(42.20) 无 28(66.67) 126(57.80) 喘息 3.468 0.063 有 12(28.57) 96(44.04) 无 30(71.43) 122(55.96) 肺部啰音 3.386 0.066 有 24(57.14) 91(41.74) 无 18(42.86) 127(58.26) 注：a为采用Fisher精确检验。 
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表 2 2组MPP患儿影像学检查结果比较[例(%)]
Table 2. Comparison of imaging results between two groups of MPP children [cases (%)]
项目 并发组(n=42) 未并发组(n=218) χ2值 P值 肺实变 3.121 0.077 有 28(66.67) 113(51.83) 无 14(33.33) 105(48.17) 胸腔积液 11.858 0.001 有 15(35.71) 30(13.76) 无 27(64.29) 188(86.24) 肺不张 2.180 0.140 有 8(19.05) 66(30.28) 无 34(80.95) 152(69.72) 支气管扩张 0.538 0.463 有 12(28.57) 75(34.40) 无 30(71.43) 143(65.60)
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表 3 2组MPP患儿实验室检查结果比较[例(%)]
Table 3. Comparison of laboratory examination results between two groups of MPP children [cases (%)]
项目 并发组(n=42) 未并发组(n=218) χ2值 P值 白细胞计数(×109/L) 3.067 0.080 ＜8.61 27(64.29) 108(49.54) ≥8.61 15(35.71) 110(50.46) 中性粒细胞计数(×109/L) 3.693 0.055 ＜5.34 29(69.05) 116(53.21) ≥5.34 13(30.95) 102(46.79) CRP(mg/L) 12.062 ＜0.001 ＜20.13 16(38.10) 145(66.51) ≥20.13 26(61.90) 73(33.49) LDH(U/L) 12.745 ＜0.001 ＜361.25 15(35.71) 142(65.14) ≥361.25 27(64.29) 76(34.86) PCT(mg/mL) 8.053 0.005 ＜0.12 20(47.62) 153(70.18) ≥0.12 22(52.38) 65(29.82) ESR(mm/h) 6.134 0.013 ＜25.26 18(42.86) 138(63.30) ≥25.26 24(57.14) 80(36.70) D-D(mg/L) 8.653 0.003 ＜1 021.45 17(40.48) 141(64.68) ≥1 021.45 25(59.52) 77(35.32) CK-MB(IU/L) 3.386 0.066 ＜21.42 18(42.86) 127(58.26) ≥21.42 24(57.14) 91(41.74)
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表 4 MPP患儿PB发生影响因素的多因素分析
Table 4. Multivariate analysis of PB in MPP children
自变量 B SE Waldχ2 P值 OR值 95% CI 热峰 0.842 0.456 3.410 0.067 2.321 0.950~5.673 热程 1.428 0.435 10.777 0.001 4.170 1.778~9.783 胸腔积液 1.102 0.475 5.382 0.021 3.010 1.186~7.637 CRP 0.871 0.311 7.844 0.005 2.389 1.299~4.395 ESR 0.856 0.502 2.908 0.089 2.354 0.880~6.296 LDH 0.901 0.361 6.229 0.013 2.462 1.213~4.996 PCT 0.864 0.462 3.497 0.062 2.373 0.959~5.868 D-D 0.913 0.481 3.603 0.058 2.492 0.971~6.397
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[1] 邓德凤, 徐军茹. 支气管肺泡灌洗术联合谷氨酰胺治疗对难治性肺炎支原体肺炎患儿支气管黏膜和胃肠功能的影响[J]. 感染、炎症、修复, 2022, 23(3): 154-157.DENG D F, XU J R. Effect of bronchoalveolar lavage combined with glutamine on bronchial mucosa and gastrointestinal function in children with refractory mycoplasma pneumoniae pneumonia[J]. Infection Inflammation Repair, 2022, 23(3): 154-157. [2] DING G D, ZHANG X B, VINTURACHE A, et al. Challenges in the treatment of pediatric Mycoplasma pneumoniae pneumonia[J]. Eur J Pediatr, 2024, 183(7): 3001-3011. doi: 10.1007/s00431-024-05519-1 [3] 张松林, 熊蕾蕾, 余燕娟, 等. 血清IL-6、RANTES与儿童难治性肺炎支原体肺炎的关系[J]. 中华全科医学, 2023, 21(4): 619-621, 684. doi: 10.16766/j.cnki.issn.1674-4152.002944ZHANG S L, XIONG L L, YU Y J, et al. Expression of serum IL-6 and RANTES in children with refractory pneumonia caused by mycoplasma pneumoniae and their relationship with prognosis[J]. Chinese Journal of General Practice, 2023, 21(4): 619-621, 684. doi: 10.16766/j.cnki.issn.1674-4152.002944 [4] YANG L, ZHANG Y Y, SHEN C Q, et al. Clinical features and risk factors of plastic bronchitis caused by Mycoplasma pneumoniae pneumonia in children[J]. BMC Pulm Med, 2023, 23(1): 468. DOI: 10.1186/s12890-023-02766-0. [5] JIN P, HAN C J, GUO W, et al. Mycoplasma pneumoniae pneumonia-associated thromboembolism with plastic bronchitis: a series of five case reports and literature review[J]. Ital J Pediatr, 2024, 50(1): 117. DOI: 10.1186/s13052-024-01690-1. [6] LIU M Q, WEI D W, ZHANG T Q, et al. Distinct clinical characteristics of bocavirus and Mycoplasma pneumoniae infection in children plastic bronchitis[J]. Immun Inflamm Dis, 2024, 12(8): e1373. DOI: 10.1002/iid3.1373. [7] 中华医学会儿科学分会呼吸学组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J]. 中华实用儿科临床杂志, 2015, 30(17): 1304-1308.Respiratory Medicine Group of Pediatrics Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Applied Clinical Pediatrics. Expert consensus on diagnosis and treatment of mycoplasma pneumoniae pneumonia in children (2015)[J]. Chinese Journal of Applied Clinical Pediatrics, 2015, 30(17): 1304-1308. [8] 刘佳惠, 马丽, 李芳. 列线图模型在肺炎支原体感染患儿中塑型性支气管炎发生的预测价值[J]. 温州医科大学学报, 2023, 53(3): 209-214.LIU J H, MA L, LI F. The predictive value of nomogram model in the occurrence of plastic bronchitis in patients with Mycoplasma[J]. Journal of Wenzhou Medical University, 2023, 53(3): 209-214. [9] 吴超雄, 王爱敏, 蔡振荡. 肺炎支原体23S rRNA突变与患儿临床特征及耐药性的相关性[J]. 中华全科医学, 2021, 19(4): 603-606. doi: 10.16766/j.cnki.issn.1674-4152.001872WU C X, WANG A M, CAI Z D. Correlation between 23S rRNA mutation of Mycoplasma pneumoniae and clinical characteristics and drug resistance in children[J]. Chinese Journal of General Practice, 2021, 19(4): 603-606. doi: 10.16766/j.cnki.issn.1674-4152.001872 [10] 崔小健, 张嘉懿, 郭文伟, 等. 儿童难治性肺炎支原体肺炎发生塑型性支气管炎的临床特征及危险因素分析[J]. 重庆医学, 2024, 53(12): 1812-1817.CUI X J, ZHANG J Y, GUO W W, et al. Analysis on clinical features and risk factors of plastic bronchitis occurrence in children patients with refractory Mycoplasma pneumoniae pneumonia[J]. Chongqing Medicine, 2024, 53(12): 1812-1817. [11] 穆世茵, 邹映雪, 郭永盛, 等. 儿童重症肺炎支原体肺炎发生塑形性支气管炎的预测因素[J]. 中华儿科杂志, 2024, 62(9): 861-866.MU S Y, ZOU Y X, GUO Y S, et al. Clinical characteristics and predictive factors for plastic bronchitis in children with severe Mycoplasma pneumoniae pneumonia[J]. Chinese Journal of Pediatrics, 2024, 62(9): 861-866. [12] 李华, 张晓莉. 难治性肺炎支原体肺炎患儿临床特点及疗效分析[J]. 血栓与止血学, 2022, 28(2): 235-236.LI H, ZHANG X L. Clinical characteristics and curative effect of children with refractory Mycoplasma Pneumoniae pneumonia[J]. Chinese Journal of Thrombosis and Hemostasis, 2022, 28(2): 235-236. [13] 杨菊萍, 丁春杰, 陈静, 等. 小儿MPP并发塑型性支气管炎的临床特点、胸部CT影像学特征及相关因素分析[J]. 中国CT和MRI杂志, 2024, 22(2): 61-63.YANG J P, DING C J, CHEN J, et al. Clinical characteristics, chest CT imaging characteristics and related factors of plastic bronchitis in children with MPP[J]. Chinese Journal of CT and MRI, 2024, 22(2): 61-63. [14] 单怡俊, 张育才, 史婧奕, 等. 儿童支原体肺炎并发器官功能障碍危险因素[J]. 中华急诊医学杂志, 2022, 31(6): 755-760.SHAN Y J, ZHANG Y C, SHI J Y, et al. Analysis of risk factors of extrapulmonary organ dysfunction in children with severe refractory mycoplasma pneumoniae pneumonia[J]. Chinese Journal of Emergency Medicine, 2022, 31(6): 755-760. [15] KIM S H, LEE E, SONG E S, et al. Clinical significance of pleural effusion in Mycoplasma pneumoniae pneumonia in children[J]. Pathogens, 2021, 10(9): 1075. DOI: 10.3390/pathogens10091075. [16] CHEN P, HUANG Z, CHEN L M, et al. The relationships between LncRNA NNT-AS1, CRP, PCT and their interactions and the refractory Mycoplasma pneumoniae pneumonia in children[J]. Sci Rep, 2021, 11(1): 2059. DOI: 10.1038/s41598-021-81853-w. [17] 焦安夏, 马渝燕, 饶小春, 等. 儿童肺炎支原体肺炎细菌性肺炎所致塑型性支气管炎15例临床分析[J]. 中国循证儿科杂志, 2010, 5(4): 294-298.JIAO A X, MA Y Y, RAO X C, et al. Plastic bronchitis caused by mycoplasma pneumoniae pneumonia and bacterial pneumonia in children: 15 cases clinical analysis[J]. Chinese Journal of Evidence Based Pediatrics, 2010, 5(4): 294-298. [18] 孙芳, 王军, 陈伟超, 等. 16例儿童塑型性支气管炎临床特征分析[J]. 四川医学, 2021, 42(11): 1113-1116.SUN F, WANG J, CHEN W C, et al. Clinical characteristics of 16 children with plastic bronchitis[J]. Sichuan Medical Journal, 2021, 42(11): 1113-1116. [19] 姚慧生, 刘立云, 伊丽丽, 等. 儿童重症肺炎支原体肺炎所致塑型性支气管炎的临床特点及危险因素分析[J]. 中国小儿急救医学, 2021, 28(8): 673-678.YAO H S, LIU L Y, YI L L, et al. Clinical characteristics and risk factors for plastic bronchitis caused by severe mycoplasma pneumonia in children[J]. Chinese Pediatric Emergency Medicine, 2021, 28(8): 673-678. [20] 王定荣, 黄璇, 魏文, 等. 小儿肺炎支原体肺炎发生塑型支气管炎的危险因素分析[J]. 中国急救复苏与灾害医学杂志, 2022, 17(7): 943-947.WANG D R, HUANG X, WEI W, et al. Analysis of risk factors for the development of plastic bronchitis in paediatric Mycoplasma pneumoniae pneumonia[J]. China Journal of Emergency Resuscitation and Disaster Medicine, 2022, 17(7): 943-947. [21] WEI D W, ZHAO Y D ZHANG T Q, et al. The role of LDH and ferritin levels as biomarkers for corticosteroid dosage in children with refractory Mycoplasma pneumoniae pneumonia[J]. Respir Res, 2024, 25(1): 266. DOI: 10.1186/s12931-024-02892-1. [22] ZHANG X, SUN R Y, JIA W Y, et al. Clinical characteristics of lung consolidation with Mycoplasma pneumoniae pneumonia and risk factors for Mycoplasma pneumoniae necrotizing pneumonia in children[J]. Infect Dis Ther, 2024, 13(2): 329-343. doi: 10.1007/s40121-023-00914-x [23] 李欢欢, 王军. RMPP患儿血常规、免疫球蛋白、D-D表达及预测塑型性支气管炎发生风险的效能研究[J]. 河北医科大学学报, 2021, 42(8): 914-919, 938.LI H H, WANG J. Blood routine, immunoglobulin, D-D expression and their efficiency of predicting the risk of plastic bronchitis in children with RMPP[J]. Journal of Hebei Medical University, 2021, 42(8): 914-919, 938. -
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