儿童塑型性支气管炎53例临床回顾分析

Clinical retrospective analysis of 53 cases of children with plastic bronchitis

目的探讨塑型性支气管炎(plastic bronchitis,PB)的临床特点,提高对儿童PB的认识。方法回顾分析天津儿童医院自2012年10月至2014年1月收治的53例PB患儿临床表现、实验室、影像学和支气管镜检查,以及吸出物病理分析、治疗经过、转归等。结果 53例患儿均经电子支气管镜检查吸取或钳取肺内塑型样物质,并经病理检查确诊为PB。患儿均有发热、咳嗽病史,发热峰值均>39℃,80%以上患儿发热时间小于1周,最短发热时间仅为半天。患儿均为首次发作,X线胸片及肺CT均示大片实变,63%合并胸腔积液。支气管镜直接去除阻塞气道的塑型性内生异物是治疗PB最有效、最直接的治疗方法。还须辅以糖皮质激素等药物治疗以及体位引流、胸部理疗等。53例患儿平均住院12.6 d,病情好转或治愈出院,随访3个月未见病情反复。结论塑型性支气管炎为儿科急危重症,病情进展快,凡临床上急起高热,咳嗽、气促,肺部影像学急性进展,出现肺大片实变、肺不张及胸腔积液,血C反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)呈数倍升高,常规抗感染治疗无效,需警惕急性塑型性支气管炎可能,建议及早行支气管镜检查及肺泡灌洗治疗。

Objective To investigate the clinical features of plastic bronchitis （PB） , to improve the understanding of PB in children. Methods The clinical manifestations, laboratory, imaging, bronchoseopy, aspirate pathology, treatment and prognosis of PB in 53 neonates treated in Tianjin Children＇s Hospital from October 2012 to January 2014 were analyzed retrospectively. Results Fifty-three children were finally diagnosed with PB by the pahtology examination of bronchoscopy or plastic like material of the bronchus. All the included 53 cases had the symptom of fever and cough with the higest temperature of 〉39℃. Of the included 53 cases, more than 80% of them had the fever period less than 1 week with the shortest fever period of less than half a day. All the cases was firstly diagnozed with the X-ray or CT presention of lung consolidation. And about 63% of children had the presention of pleural effusion. The best efficacy treatment pro- cedure for PB was directively removing the plastic like materials combined with position drainage, physiotherapy and glu- cocorticoid. The mean hosptial stay was 12.6 days with cure or improvement. After 3 months＇ follow-up, no recurrence case was found. Conclusion Plastic bronchitis is severe acute disease in Department of Pediatrics. The clineial characteristics of PB are rapid development with high fever, cough, dyspnea, lung consolidation and pleural effusion. Clinial laboratory exmination usually demonstrats significant elevated serum CRP, PCT and ESR, which indicats non usefull for regular antibiotic treatment. When PB is diagnosed, the best treatment procedure is bronehoalveolar lavage therapy.