兒童肺炎支原體肺炎診療指南（2023年版）

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#?MtSIC 7&.!SIC ^YH&5%

2023 1 D

6&? e 6&m?y·coplasmapneumoniaepneumonia ?MPP

e G35 ? @ u1 6 q??,”/t p9 ? ](6com&m?unity

acquiredpneumonia ?CAP)> ? U )H + ′ §H ++? `

>*< "? =F !– ′ DF+,”MP+PBU "e?,” n ? ′ 'KdL$

N? > p! ?3 ?+U P 3 u1 q c ? ·OG

0 ] Lz M u1 qL (? jMPPBˇ u+1? = >3 u

1 q c ?4?4 …3 ? n+? j .J0? c ? =3 u0 ? n =

+ =>v#? = § = P′ =9￥ 1 P 0 I ? ?’) ?3 ? LA

? ′5 P′ l — … bB +? = ? U = 2 ′??99MPu0P,” q > /

B "? ? G ? +U(9￥(,” C >*< +^ ? G DF+ =L

)‰ = E– q+?CU ?1 > b = p q = 2 ] O ? :f :4

^ j D+ c ?5 > ? ? oF +^ >6 = —

6&? e 6&M?PP· ? =6&? e mycopl·asmapneumoniae,MP U KC?,”6G &?+ ? % 3e e"J1 =4 e"J1 =6# ′6L*C^ >

L"? ]6&? e 6r&efr?act·orymycoplasmapne u-moniaepneumonia,RMPP ? =MPP u +^ ]) ?G￥2– ?: 9￥

(!??"?+?7d @ ? 75# ’# = j ?B 6G §

? H = 0)6 L ? +6; >

]) ?G￥2–9￥( ? ]6&? e macr6oli&de? ·

-unresponsiveMPP ?MUMPP ? =MPP u5 E ]) ?G￥2– ?:

9￥(!??"?+?72h ? 75# ’# ? j ?B 6G § o

L ~F 6! HMP,”P>

$- > U 1 ? ' >j

MDP6F9￥ = 8 n +?&?+ ?MU,AMPPa* ? _ ? U ? ~,”"?

+? ? GH + ′ DF+,” +U >

H +6&? e 6&se?ve·reMPP,SMPP ? =MPP+? ? [H ?1\ >H +CAPZ — = ?B ? j <` >

§H +6&? e 6&? ?= u+? ?E?FUF =0) ?1# L § +U ?,”6 L ? + ?M6??F >+U ? e 7"?+?,”

SMPP>3 L ‰)d <!MP2P–0& p ? ]6&? e 6&?

·fulminantMPP,FMPP >

′ = +? p l

+? p l P ‘ ′ LF D ?-$ A p q?? pMlP?-*Z0 ?

Z ′ ? q 8 n,” +? ?1MP o?>? nF ? _+^U Lz

47 Lz-v ?47 >M ?FPEH t"]8+g 0 =/t p9 ? ] ? n0?

F!52 > ?" 3V1 p lFV F ? nF @,,”-* Z ˙ ? MqP/U

,” 8 n +? ?1 %FPE8D? +? ? =E ? =+

F1 P0 FJ ” 28*6 ′6 L4?4,” +? Z >? q 8 n +1^SMPP=FMPP 6 L ? +,” +U cC? …H ?? +^ ? F

FMPPj ′ § ,” P m ] >

? =+?*<>)

E–+6&?6# 7 ? ? c ]2¨47 #fi# H?

+ 6;6# 7 ′6

# F j ?$ *47 =#|47 = ￠47 #fi# ?6# —6? ?D U6# % +U45* L ?6# 7$M 0( ; "45*= ,?

￥6? m p L4?4 > % +U6# 0>v > e"J1 =4 e"J1 3e>)

p @,47 !– ′7g:s ?4" .j ?1 "j6? ?1 UA7$

*47 /′ L ￠47 #fi# ? ~ > m o ? % ?

47 #fi# ?17 ?#fi#47 2– r6# 7 ?! L a ?U #?(C^ ?

,47 .j D>? !,” F45*47 5 ?D U17 ′1 ^45* L ? 28*"JF ￡ ( ′L# >

= j >)

MPPP? ?5 ? @ u15

??|

A u1 % +? >

’# =? 3 p q?? j >) ?% j ? j, =#w#? =, =6i, 1’# cQ ’# p q ? 75#Q ’#6;N”/p+? ?H > ? 3E? p &

2– r,· ? m ? 3 >G < u ? ? ￥>) ? “ ? u P?

U ? % C D t ?Lˉ+? ?F % 0)

>

′?¤nN=)$L] ?

SMPPP +U ?+?0A1 ) ? j ?6 ? ′6 L ? + ?9

] e"J1&p?las·ticbronchitis,PB = c1-]H

7.70%#? =]M0%6 ′!– =6pulImonar·yembolism,

PE1 , ? u % 0)"J ? L ? n&L ˙ +U6 I ,” uF

0)7., ′ >v ˙ +U6 L ? + , % 0)-. ?7E Z,” j

>) >6 L ? + % +U ?,62?7 =/5 315 =>v#?315 =

)315 1 ?0)-. ? :315 ,”>) ?n?6 L ? +?1b wG < >

G M?PP% p §H + ?n ? n&L ′ ? n>?1# p0?

>) ? D [ ] ? n0?F!52 >=?]"JF +PUB= [%a ]4 e"J

1&? [PHE1 ? ' > ‘ a+? ` [H 6 L ? + p q??>

) >

3 ? ]) ?G￥2– ?: 9￥(6F9￥,”MP U E? ?F ? %73 e 2

8*SMPP=MUMPP RMPP +U,” q?? 6 >

? = § >)

§ >) e j Z a+? ? [H 0A ′A? fN” D,” q??

? 6 >

MPP U7.(} L7.GCT q??>) p e"J1>v1 *4*<

2? = P = e"J1 — ? % ?/ )?*? § = G8 ? =L? — =5 r §1 >6# &? ] o O 6# 3e,”99*6B 8 ?

?/ )?*? mLj § = ˙(}( =8?!o y8) ] , ] ? n?6 C V ?

% j ?6L §]H? 6; % > ?7.70%#? > +? E? P?

+?&? ? % j L C j e"J1 {"J ?

6?

-,Q~)cLj § ?

M0%C ] = 3e6 ,C P O CQ > P0 7 =

′ C},”+?&? %$- > 0) > % j ?U #? ? >

G M<PP%>) p vL L [%a ]4 e"J1&?(fl ? 7?.G Q <

ECT·HRCT t/p p E , c ?5 8? § = G8 ? = < e m4

? =4 e"J1 V P￠C ?B ? % B , j ? e"J1&0) e"J1 — ′ <# ( k >

MPP0)6 ? ? + , ?PE?=!– ]6&(?necrotizing

pneumonia,NP) ? %)0-. ?,” § o(? ? +)>

￡ = % e ( e"J1K A>)

% e ( e"J1K ·1?0& e"J1K A>) D+?0A

? [H 0A ? ' >E–6; e"J1U 7 {>v ="j6? ? ? E5 8?0?C? ?17 % ? <# ( >GMUM<PP=SMPP RMPP u e"J17

^U #? I ?% ′ k 17 ?U 7 %!– =7g:s L$?+

+P6;E￥P.j ′?.Mh G?

<+? `4^+?02A

D 0)17FP"J C

8￥ = +U =)#0” ′L# >

9 = P′

6 +? ′>v$;

1.MP / – ? eB MaP U ,” H = ?M|+Pg/?–

M6??(fl! , J+UK5I ?L ?+^ ? j B a >

2.MP nGfi # ? ;M"P-DNALMP-RNA# ?&? ′(fl

8 ]Q ?F8+^M?PP,” UB a >

3.MP ? # —MP-I?gM ? 68b^ U 4-5Dd 0) ?%

p U U ,”B a = = >N?2¨

paLrtic#le

agglutin a-

tion ?PA# e P′ # —>MvP$-;IgM ? ,” q?? # ?

3>v$; ? %* 1:16P0 % MPpF U U ,” = ># —

IgM=IgA =IgG1 —2– ? ,”G?6 +? nLz# = L # /

aMP U ? - r ? |Li ] ?&3 ? P 5 6 = > +?7,H # % — ]MP-#IgM ? ?Li ] /MpPU ?Lj ] O C73 ′

¨LMPU ?F8 >L [B u !FU1 ?| % 0) }Li

! Z — ? #5 ?5 > j ′ § (fl ? 52

′ 68b

L >v,?47 q ? 68b! n ? D U %E–SMPP}Q u>

P ? ’3#d D 0) c ]2¨47 "C- = ?= ,?C-·reactive

protein,CRP = 'Gfi7g"XG?lac·tatedehydrogenase,LDH

D- ′6 =>v$;J= ,? 47 C B0A

=

}Q

?

[H 0A ? ' ? eE p +?&?+ ?,” =SMP>P6

u

%

?,?= ,?LS>MPP u c ]2¨47 "CRP′ D t }Q

%

73 D4: $- > U ? ' >

? MP,”6F9￥ ] #

.? —MP6F9￥,”H = # e +^0 / –Li ],”: :sF >

?: 9￥( 6 ˙: # # — ?F ^ j D+ cMPL/

"j

L2617 &1.

'6F9￥ ?2617

00? ? ?20c63

&,”. 00?

L2064 &0?

28* "j '6F9￥

>-$

% 28*Q

^ j

@ ?FPE# —

@F& &0?

Z a6F9￥ D \

?|

v #,”6F9￥(

D j +? ~ ?

C ′ 68* ?j

5 v %73F

D

]) ?G￥2–9￥(

+?B98? +^

+?0A8L1

3V ? ' >

]) ?G￥2– ?: 9￥(6F9￥ p l q??23pSrRNA 0 2063 =2064

6 >

? =B a

1\ > @ j ′ §

>) ?5

>

A 1

6Nfl

L

%B aMpPP?

·1 3>v$M;P? %*

1:16P0 ·PA#

˙+?0A

c

3

>v$;MP? %* 4@C}

@ >

·2 MP-DNALRNALi ] >

=H“ aB a

6 D+?" ]6&?H“

a

1.7+?" ·ADV6&?

P 6? >-2 ? u1 ?H + u c" +(H ? P ? ? ` ?

U bB 6 ? ? nN) ?q??H“ a ? p#w>+? ( ′+?

>|M6A

7+??" %

MDP$- > U >

2.#w U+?" 6&?

#w U#w> 8? P? ?P ?#w

#Uw

LU+˙r6; @ ( ?

’# = @ ? nF U +(C?+? ?Lˉ D 0) ? 3 H = ? n&

6G ? ?§ MPPD? ,2– r >? nF = b+? +h`

L `#w U+?" ? L nGfiLi ] %.?B >3. ` (+?" 6&?

#w>+? (0? 0 ?7.GCT 6 n?,”>) e/ )?*? § = 6L \ p q,” P E ˙(} § =L*C^ o ? [H 6; % 0)6

?? ?#w>+? ′+? H“ a >

′ D4: ]6&?H“ a

6&?K4*9:

S·P ′H T?8¤:::*9:

SA·

14: KC?,”H

+6&? n^+?0A S U Z

3?de

? 0),?47 q ? = c ]2¨47

" C=RP=PCT D t }Q >4: ]6&C??,”K0#T n +U ?+?

0A1 ) ?M6BPPP^2 D ?H“ a q?? ?+? MP% D4: $- > U >

? D65 nH“ a

65 n+? (-. /E?K ? ? 3-. / CH > § >) p ?

]65 n ^4Lo? L6L $ *5 6? ] 5˙ ]65 n n^ gB ,

' ?0#T F ˙5 n ]7.7&? 0) c f ]H 7.70%#? , ?n C j6 >68b o ?5 n @ ( ?j >) ′ § >) CL

??? ,F >PPDB P′

′¤ ¤ ?3VH

B tP′H“ a >

w = n?6 ? L ? +,” UA a ′B a

6 6 ? ? +

PBPB e KCS?MPP′FMPP,”H ?? 6 ? [H 0A

? ? (,” ] E ′ 5? ? ( ? +U^ ]"JF ?% 76

? ? eFMPP p FP"J ~ C ',” q?? PB6>eSMPP

′FMPP uF+L# ] e"J1&?,”H ??

PB

*6P>? ?

? ‘ /

E C^6;

M>PP u 0) 75#Q ’# = ? ￥ ="J

? L ? n&L ? ^ ? / ? ?, A"J6? ?6G ? nN) g# g ?7.G § t/p “ ,Q 6 6 C V , ?M6

b+? ? e"J1K %.?B >

2.PE %)"1 +U L ? ? G I NP,?”e +U

6 ? eF+6 C V ′ p L ]6&?,”H ?? ?% j ? e"7 ?>v I >MPP u 0) 75# ’# =7.G § /p ] ,} 6

68*Q L7.7 A , ?M6A b+?,” %7

7., ′/ L >vD-? ′6 5mPg/L·! n ?6999*0-0.55mg/L

? ?B aCT?6 7?FV §C·TPA t/p6 7? ? {,5p ?

F 1%>v1 < e G L# g C t § =6 +? %.?B >

3.7.70%#?0%#?H PCG1 ?P p ?68b C F ;?/

]0%#? > 0) 75#Q ’# =7., = ? n [ ? , ?M669< b+? ?F

>7.G C? &X4L? % D.?B a >7."j ,?47 q ?E– }Q ? c ]2¨47 L$ *47 p q ?= ,? aH }Q =3 aH !

0)>v ]7.70%#? , ? ?APE>

4.NP q??>) p 75#Q ’# ′ ? 3 ?[H , 0) "]>v+

? n&LM>PP u 0) 75#Q ’# =“ ,} 6 68*Q 6 CRP D t }Q 6; ?Q /p ? +U b+?,” %73 ?M6 7??

L ? 7X.G4? L6CT^6 p 0) #?"J ',” P

a"J 7 L;” 0#T %B a >CTp L% 0) !–p >

0#T P +U ?+?20A D ? e"J17.7,N 6 ]+1 C P? >

5. e"J1 $ ? [ ] MP eB’ $ ? ,”H ?? ?

Z ? e ? ‘ L E (,” MuP

>U?

E0A c 0) D t

? ￥ ="J ? = ? n&L , ? ?69< b+? ? % o ? / e"J18H V

,”"?+? ? e"J18H BV P′1 ?.?B >

$- > U $- > U P?SM?PP=RMPP′+?0A D U ??

F+?01A0d ?4: 0)‰41^0% )M>P% ADV= ? nF >7 +?" =Uq+?" ′#w U+?" 1$- > U ˙$-S>P4=:

#w U >v |:

SA=

p q ?$- >6F9￥M ?Lj ] |: U ,”CF

P M>P % D6&?> = 6 : $- > U ? > ?-U:

n |: U E? G? >

′ 6 L ? +

1./5 315 3e ; "7G&? =[ ] a ]7G7@Q &? =‘Ce ]

7@Q &? = ? ? ? *M-52 > ? =7G ? 1 ? 7G&? 6 p n?MPP u 0) F = EA o 1+( , ? ?69<F ++? >

2. )315 3e ; " ?7E ?>v I =7I" ] G = ?6′&? =

? ;&? = D+? =7? I ′M7?>v I SFM1PP

u ? ?# EF ? + >

?′F/M?PP

3.>v#?315 3e ; " +? ]>v E G+ =8D? +? ]$

>v ]Ca>v = ￠>v47 52 > ? = [ ]>v1 ? >vL1?>v0

) ?31 L 631 D t G , ? ?# EF ? + >

4.,6U 7 ?; "9T?+ =E ]3a, = P 4 ˙ = (

:? ‰ ?46&F@52 >ste?ve·ns-Johnsonsyndrome ?SJS =

c" ]!– ]>, ·@ +tox·icnecroticepidermolysis T?EN

MPB’ ,”,+U 7&?m·ycoplasmapneumoniae -induced

rashandmucositis ?MIRM1 >

5. ? >) ; "6 E*96&? > ? [H ) {>v LQ >v `

§B = [ ]6 Z =6 73>?1]#7&=7&[? = '8?&? =‘46′

$@ 52 > ?1 >

w 6 = j <`

MPP~) 8C^ ]>) ? j <` ? _ ? A aH + ′ §H

+ +U DF+,”Q § 5 ?? _ ? = 2 ‘ L"?+? >^ ’5-7 _ ? ·5 ] P ? u^! UL*+? ? EQ & = D

,C^%3V +^ F > Z a p >

6 E–+

C1\ >H +>)6; ?+?0A

CF+ DF+ >

′ H +

7P-^10d ) ? 68bN” D8￥ ? ?

1\ > A M>) c,” 1 6Nfl ?

1. 75#Q ’#

ALC` ? ˙

3·9 @5

_PL ’#7

P_ ? $_Q &

2. 0) ? ￥ ="J ? = ? n&L =7., = >v1 6 >F >

) D+? H= > ? ] e"J1&? = $ ? =7.70%#? ′6

1 ? ' ˙

3. 0)6 L ? + ? | ‘E f §H + = ˙

4.M ￥( 7 A ? n0"J , =7?"]O§ ′0.93O>

5. § >) A ? o 166;

? ·‘6 ,2/3P

3e ?

^} 6 68*Q 2 ‘L @6 , 0)Q ·

A 3eM0% ] E ? % j ? c f ]H 7.70%#? ? % j ? vL

4 e"J1&?>)

(˙2) 6 [%a ] L

4/5 6P , ?4 e"J1

&?>) ? % > ? e"J1&? ? ? ?U #? I F 28*6 C V >

6. j +(F > ] H ? § t/p+?

C?E50%˙

7.CRP=LDH=D- ′6 6 D t }Q 6; >

249-94*8h^F

§ >)1p6·; ?M669< ^U #? I kPB˙′/ ?

CRP=LDH′D- ′6 1 D t }Q 6; ? M669< DNP? p

,” %73 ˙F ?69< ?PEL$- > U ,” %73 > b` IF+L#

] e"J1&? ?j ?4 e"J1&?6; ?% B ,F+L# ]4 e"J1&? >

§ >)2p·,” u ? P ?E C^ ? n 0) ? ￥ ′"J ? ? ?$- > U ,” %73 ? %E?FU p ? n>?1IC#U? e

p FP"J+? ~ C ',” 6 ? IF+L# ]4 e"J1&?

-$ j q+UMP/4 e"J1&? …@ -. / CC? ? IB%B ′%EB ?M6 pAA >

? §H +

= ^ ? n>?1# ′ · L § +U ?,” [H 6 L ? + ?M6p FP"J1+U ? e 76; >

w ′ =H + ′ §H +,” UN”A = =

A = = /p ? pH + ′ §H +,”O(jiān) L ?

·1

"?+? D72h 75#Q ’# CF6 ˙

·2

^ U c" +( ˙

·3

+? ? ′ § F E?FU

?

P6

,#fi# ˙

·4

CRP=LDH=D- ′6 AL=T D

t

}Q

? 0),”

,L*C

9￥(

; "

C

′M4

L9￥(

?

%E?

p

¨,&

=

1

¨,&1(

+?#

>

?+?

?CH

˙

·5

"?+?

D

"]>v+

′

? n&LL

5I@

LF

˙

·6 ^ 0.v++? ?; " $ ? ′ ] +?5pL?+?1++? ˙

·7 ]) ?G￥2– ?: 9￥("?+? ,F >w ? ="?+? O

H & e UA a ′"?+S?MPP′FMPP> 6 '"?+?0? U p

’# D5-10d ? ?+?01A4d D 75# ’# ?+? ? ?E￠6; ? n

F+ DF+ >

H“ ?MPPj >),” 8C^ ] ?? o ? <` l — ‘ L,”"?+?

~ >E–+ uLMP"??+? L ? C ? n?? +^ D? ]3 ,C^%3V"?+? ˙H + u ?G C B H ,”52 >"?+? · ? U =3

%3V = e"J1K = ? 16 > ? ?? '# $- > U ? ??A a ′"?+?E p&?+ ? 47 O ? ?9 C , l ?73 $- > U′DF+,”+Up)‰>

E–+ CM6

L ? =??

+? ?

L ?#>v n??= ′&?+

1

?# EH +

′ §H +A a

>

{ < G ￥

′73H z ?

A"j

′+k@ C^ '> >5 >+? ?5

F8

"]+? >!.?

C+^F6’#9￥ ? /

? ?Q

( 7 ?/?O 6; ?M6> {

"j

′+k@ C^ >

¤ ? D t §

G ￥6;

? %G ? ?+^K} ?9￥( >

6 68b ′ /+"?+?

′ M?P"?+?

1. ]) ?G￥2– ?: 9￥( pMPP,”O(jiān)F?"?+? ? ; "Lu }M?

3V = M?3V =4M?3V =54M?3V ′ G? ? M?3V >Lu

# ?E–+ %10mg/(kg.d) ?qd ? C LM& ?3+d?0A? ??? ,

% ,K85)d ˙E–+ %1b106mg/(kg.d) ?qd ? D

5mg/(kg.d) ?F +^4 _ >H + 9Lu }M?3VM10m&g/(k?g.d) ?

qd ?F +^7d ) ?L*L3?-4d D 6

21b

‘+?0A ? q+?0A ?+?

?6B — ?P2-3p ‘+?0A ?+gM7?E￠ p C5 9￥,” , p p u

+? ? E– = j +( o ” = $_! n , > / “ ? u ?Lu }M?3V

o ? $_ ?

o1 S!A? -9￥(+? ~ > M?3V+^#

?

10-15mg/(kg.d)

?+?0A 68b p10d ) > G? ? M?3V+^#

?

25-50mg/(kg.d)

?+?0A 68b 1p0-14d >4M?3V+^# ? P p

30-45mg/(kg.d)

?+?0A10-14d >54M?3V+^# ? P p

5-10mg/(kg.d)

?+?0A10-14d >

+^ Z ? eM7? l x?? H > ]) ?G￥2– ?: 9￥(72"h?+?? D

2. ` )3V2– ?: 9￥( q?? ; " P?)3V ′2'B0)3V ?e"?+?MPP,” 5 9￥( ?/6F9M￥PP? ?.? =+? ~ ?+^ ? %+˙ L.?

—,”MP6F9￥,”MUMPP=RMMP=SMPP"?+? >+g ? %73 28*(U

T? ′(GC^ 6? C8￥ ? ?F88+^??

@ u18 ?>

A u1

+^ C?B* D +^9￥ ?M6 { <A? f _ @ ? ? ? K. ? BB0)3V,” +^-. /E? p ?P?)3V,” ? ]E?Q ?^ 9 xH ′

+?0A ? ?P 7 {(UT? ,”

P?F)3V>

?9 xHp2mg/

·kg.!W q?12h ? C L6;M7? >2'B0)3V ?O4mgx/ ·kg.

!W ? 6 ]H CC2?0E0mg?L*L?12h D ?+^5* 7H2mg/ ·kg.

!W q?12h ? C ?" !W 6 ]H

1C0C0?mEg> 68b+?0A

1p0d >

3. B0G?2– ?: 9￥( e"?+?MPP,” 5 9￥( ?/6F ]) ?

G￥2–MPP? ?.? =,”+? ~

+?^ ? %+˙ L.?

M—P6F9￥MUMPRP=MMP=

SMPP"?+? >+g ? ^ ? “ (E￥P Z ′ 2–6′7§ a>?,”O(jiān) L ?18 ? A u1 +^ C?B* D +^9￥ ?M6 { <A? f _ @ ?

K. ? B E > "]"U"6ˇ U‘ >?-5 ?

8?-10mg/(kg. !W)

q?12h ˙

5-16 ?

8?-10mg/(kg.!W)

q?d ? C LM7?# :

M˙500mGg/“d ??

qd ? 6Q xH750mg/d ?+?0A7-14d >9??"ˇ U10?mg/(kg.!W) ?

qd ?M7?# : ?+?07A-14d >8H"ˇ U ? 6mgC/(kg.!W) ?bid ?

6 ] xH180mg/!W 3?60mg/d ?+?0A7-14d >

? 3 ,C^%3V"?+?

q??+^ ?H + ′ §H + u ? n?? ?+^+h#2mgrU/ˇ

·kg.d ?G <H + u %73 ~ ?M6 o ? j >) = 3e6

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