评估放射线在诊断急性毛细支气管炎中的作用

Evaluation of the Utility of Radiography in Acute Bronchiolitis

目的确认X线片与具有典型毛细支气管炎表现的患儿临床诊断不一致的比例。同时分析X线片与临床表现的关系。方法我们对291例2-23个月来我院就诊,根据临床表现诊断为毛细支气管炎的患儿,予以拍摄胸片,比较其放射线特点及临床表现。将X线片分为3组,单一气道炎症（单纯型毛细支气管炎）,气道和肺病变（混合型毛细支气管炎）,还有与临床诊断不符合的疾病（如肺叶实变等）。结果X线片与临床诊断不符的比例是291例中占2例（0.69%）;270例患儿（92.8%）X线片为单一气道病变,19例为混合型病变（7%）;163例患儿氧饱和度〉92%,其中157例患儿（96.3%）X线片为单一气道炎症;128例患儿氧饱和度〈92%,其中112例（87.5%）为单一气道炎症。结论具有典型毛细支气管炎表现的患儿不需要摄片,因为胸片与此病基本一致,而氧饱和度〉92%且轻至中等临床表现的毛细支气管炎合并肺叶实变的机率非常低。

Objective To determine the proportion of radiographs inconsistent with bronchiolitis in children with typical presentation of bronchiolitis and to analyze ralation of radiography and clinical manifestations. Methods We conducted a prospective cohort study in my hospital of 291 infants aged 2 to 23 months with radiographs acording to clinical diagnosis of the infants with bronchiolitis, and comparison their radiographs characteristic and clinical manifestations. The radio- graphs are divided into three groups, airway disease only （ simple bronchiolitis）, airway and airspace disease （complex bronchiolitis）, and inconsistent diagnoses （eg, lobar consolidation） .Results The rate of inconsistent radiographs was 2 of 291 cases （0.69%; 95% CI 0- 1.8）. A total of 270 children （92.8%） had simple radiographs, and 19 radiographs （7%） were complex. Of 163 infants with oxygen saturation 〉 92%, 157 （96.3%） had a simple radiograph; 128 infants with oxygen saturation 〈 92%, 112 （87.5%.） had a simple radiograph. Conehtsions Infants with typical bronchiolitis do not need imaging because it is almost always consistent with bronchiolitis. Risk of airspace disease appears particularly low in children with saturation higher than 92% and mild to moderate distress.