小儿闭塞性毛细支气管炎14例临床分析

Clinical analysis of bronchiolitis obliterans in 14 children

目的了解小儿闭塞性毛细支气管炎的临床特点及疗效。方法对14例闭塞性毛细支气管炎患儿的临床特点、肺部影像学、肺功能、治疗和预后进行回顾性分析。结果 14例闭塞性毛细支气管炎患儿均有咳嗽、喘息,肺部均可闻及喘鸣音及湿罗音。胸片表现:3例斑片状影,5例肺实变,3例局限性透光度增高,1例单透明肺,1例毛玻璃样改变。高分辨CT表现:马赛克征13例,支气管壁增厚7例,支气管扩张4例,肺实变5例,透明肺1例。肺功能:10例为阻塞性通气功能障碍,4例为混合性通气功能障碍。11例纤维支气管镜结果有痰栓。结论对于病程较长的咳嗽、气喘、抗生素治疗效果不佳、高分辨率CT示马赛克征的患儿应及时诊断闭塞性毛细支气管炎并终止住院治疗,出院应在家序贯治疗。

Objective To analyze the clinical characteristics o[ bronchilitis obliterans （BO） in pediatric pa- tients. Methods Fourteen pediatric patients with BO were selected from January 2008 to December 2013 and their clinical manifestations, changes in imageology, pulmonary function, therapeutic methods and treatment responses were analyzed retrospectively. Results All the patients demonstrated cough, wheezes, and crackles. Chest X-ray showed patchy infiltration in 3 cases, consolidation in 5 cases, local in- creasing o{ transmissivity in 3 cases, unilateral hyperlucent lung in 1 case, g^ound-glass changes in 1 case. High-resolution computerized tomography （HRCT） showed mosaic signs in 13 cases, bronchial wall thick- ening in 7 cases, bronchiectasis in 4 cases, consolidation in 5 cases, hyperlucent lung in 1 case. Pulmonary function showed obstructive ventilatory disorders in 10 eases, mixed ventilatory disorders in 14 cases. Con- clusion The pediatric patients with long duration of cough, asthma, responding poorly to antibiotics and having ＂mosaic signs＂ shown by HRCT should be timely diagnosed with bronehiolitis obiiterans and termi- nate in-hospital treatment. Instead they should take sequential therapy at home.