持续性细菌性支气管炎31例诊治分析

Clinical features and therapy of persistent bacterial bronchitis in 31 children

目的 探讨持续性细菌性支气管炎的临床诊治要点.方法 对2010年10月至2014年5月在首都医科大学附属北京儿童医院呼吸二科住院的31例持续性细菌性支气管炎患儿性别、发病年龄、症状、肺部听诊、胸部影像学、支气管镜下表现及呼吸道分泌物细菌培养、对抗生素的应用反应等进行回顾性分析.结果 31例患儿男17例,女14例,发病年龄均在3岁以下,主要临床表现：有痰咳嗽,持续4～11周,病程中曾有发热13例,伴有喘息25例.所有患儿肺部听诊闻及痰鸣音.胸部X线片提示均有两肺纹理粗多、模糊,6例有散在小斑片影.肺部高分辨CT发现25例有支气管壁增厚,其中18例伴有支气管周围小斑片影,7例伴有陈旧性肺炎（5例合并条状肺不张）.6例仅表现为模糊的小叶中心性小结节和透光度不均匀或磨玻璃影.支气管镜下发现支气管腔内有白色分泌物.16例为肺炎链球菌感染.28例应用阿莫西林克拉维酸钾或第二、三代头孢菌素和加酶抑制剂2周以上痊愈.最终应用碳青霉烯类、替考拉宁、利奈唑胺各1例.结论 持续性细菌性支气管炎常发生于3岁以下,主要临床表现为有痰咳嗽持续4周以上,可伴有发热、喘息,肺部高分辨CT常表现为支气管壁增厚,呼吸道分泌物细菌培养常为肺炎链球菌,大部分病例应用阿莫西林克拉维酸钾或第二、三代头孢菌素和加酶抑制剂治疗2周以上痊愈.

Objective To investigate the clinical features and therapy of persistent bacterial bronchitis （PBB）.Method A retrospective review of 31 patients with PBB from Octorber 2010 to May 2014 in Department 2 of Respiratory Diseases in Beijing Children＆#39;s Hospital was undertaken.Result （1） The patients （17 boys and 14 girls） were 6 months to 3 years old.The main complaint was chronic wet cough （〉4 weeks）;13 cases had fever and 25 cases had wheezing.Rattle was heard on auscultation in all patients.（2） Chest X ray showed an increase in bronchovascular markings in all cases,accompanied by patchy infiltration in 6 cases.The high resolution computed tomography （HRCT） demonstrated bronchial wall thickening in 25 cases,associated with peri-bronchial patchy infiltration in 18 cases,with organized pneumonia in 7 cases （atelectasis in 5 cases）.Centrilobular nodules and ground-glass opacity were observed in the remaining 6 patients.（3） Purulent secretion was seen in endobronchial cavity by bronchoscopy.Streptococcus pneumoniae was isolated from sputum culture or bronchoalveolar lavage fluid culture in 16 patients.（4） Patients recovered completely after over 2 weeks＆#39; treatment with amoxicillinclavulanate or the second and third generation cephalosporin （including enzyme inhibitors） in 28 cases,carbapenems,teicoplanin,linezolid in 1 case respectively.Conclusion PBB often occurred in 3 years old or younger patients and had chronic wet cough for more than 4 weeks,fever and wheezing.HRCT may reveal bronchial wall thickening,respiratory secretions culture may reveal Streptococcus pneumoniae.Most of patients recovered completely after over 2 weeks＆#39;treatment with amoxicillin-clavulanate or the second or third generation cephalosporins （including enzyme inhibitors）.