儿童塑型性支气管炎24例

Clinical analysis of 24 children with plastic bronchitis

目的探讨塑型性支气管炎（PB）的临床特点，以提高对儿童PB的认识。方法回顾性总结、分析2009年7月至2012年3月深圳市儿童医院收治的24例PB患儿的临床表现、支气管镜检查结果及其吸出物的病理、治疗经过和转归。结果24例PB患儿中，男18例，女6例；年龄1岁2个月～10岁3个月，中位年龄为3岁4个月。伴基础疾病3例，其中1例哮喘，1例双肾积水（中至重度），另1例为VSD修补术后1年8个月。患儿均有发热、咳嗽和咳痰，其中喘息lO例，呼吸困难5例。诊断均为肺炎或重症肺炎，其中伴肺不张14例，胸腔积液lO例，可疑支气管异物5例，气胸，纵隔疝各3例。14例患儿入住PICU，6例伴呼吸衰竭，9例接受气管插管和机械通气。患儿均使用可弯曲支气管镜检查，吸出树样支气管管型，病理检查23例为纤维素性渗出，伴中性粒细胞、嗜酸性粒细胞和淋巴细胞浸润；1例为纤维素性渗出伴坏死。所有患儿经吸除树样支气管管型后，病情明显改善，无死亡病例。结论PB是儿科少见的危重症，病死率高。临床上急性起病、进行性呼吸困难，伴有肺不张、胸腔积液或实变时，应高度怀疑本病。尽早行支气管镜检查去除气管内异生物是治疗本病的最有效手段。

Objective To investigate the clinical characteristics of plastic bronchitis （PB） so as to improve the awareness of the disease. Methods Twenty-four children with PB were collected from Jul. 2009 to Mar. 2012 in Shenzhen Children＇s Hospital. The clinical manifestation, bronchoscopy, histology of the cast, clinical course and outcome were reviewed retrospectively. Results Of the 24 children with PB, 18 cases were male,6 cases were female, and the range of age was 1 year and 2 months to 10 years and 3 months,with the median age of 3 years and 4 months. Three patients had an underlying chronic disease, 1 case had asthma, 1 case had hydronephrosis, and 1 case had ventricular septal defect repair before 1 year and 8 months. All the cases had fever,cough and sputum,while 10 cases had wheeze, and 5 cases had respiratory distress. All cases were diagnosed as pneumonia or severe pneumonia,of which 14 case had atelectasis, 10 cases had parapneumonic effusion,5 cases suspected of foreign body inhalation,3 cases had pneumothorax,and 3 cases had mediastinal hernia. Fourteen cases were admitted to PICU, 6 patients developed respiratory failure, and 9 patients required mechanical ventilation. Flexible bronchoscopy and bronchial lavage were performed in all cases and showed bronchial cast. Histological examination of the bronchial cast revealed that fibrinous material contai- ning large quantity of eosinophils, neutrophils, and lymphocytes in 23 patients, and no inflammatory cells in 1 patient. After a bronchial cast was removed, all patients were improved greatly, and no patient dead. Conclusions Plastic bronchitis is a rare pediatric critical disease, which has high mortality. In children with rapid and progressive respiratory distress with lung atelectasis, pleura1 effusion or consolidation on chest radiograph, PB should be considered. Bronchial endoscopy is the most effective method for treatment of PB.