儿童塑型性支气管炎50例临床分析

Clinical analysis of 50 children with plastic bronchitis

目的 分析儿童塑形性支气管炎的临床特征,以期提高临床认识和诊治水平。方法 回顾性分析我院2011年1月至2015年12月收治的50例儿童塑形性支气管炎病例,对其进行性别年龄、有无基础病、临床表现、影像学表现、纤支镜表现、病理结果、病原学结果,治疗经过以及转归进行分析。结果 50例塑形性支气管炎患儿中,2-5岁患儿占48%,18例患儿伴有先心病等基础疾病。临床表现以咳嗽、气促和发热为主,部分可伴呼吸衰竭。影像学表现以肺不张为主（62%）。支气管镜检查可见黏液栓主要分布于肺左下叶和右下叶,经支气管镜可取出支气管塑型物。塑型物病理学检查结果均可见纤维素样改变和大量炎性细胞浸润。47例行支气管镜钳取或吸取内生性塑型物并灌洗,44例（93.6%）成功,16例（34.04%）行2次或2次以上支气管镜检查。43例（86.0%）临床好转或痊愈,3例复发,4例（8.0%）死亡。结论 塑形性支气管炎是儿科少见的危重病,其临床表现缺乏特异性,易误诊和漏诊,病死率高。临床上急性起病的患儿伴进行性呼吸困难,影像学表现为肺不张、胸腔积液或实变时,应高度怀疑本病。及时行支气管镜检查清除气管内塑型物是治疗本病的有效手段。

Objective To analyze the clinical features of children with plastic bronchitis , and to improve the clinical knowledge , diagnosis and treatment .Methods 50 children with plastic bronchitis were collected from January 2011 and December 2015 in our hospital , and their age and gender , underlying disease , clinical manifesta-tions, imaging findings, bronchoscopy manifestation, pathological results, etiology results, treatment and outcome were reviewed retrospectively .Results The number of 2-5 years old children was 48%in 50 cases, and 18 cases of children had congenital heart disease and other underlying diseases .The clinical manifestations were mainly cough, wheeze and fever , some cases even with respiratory failure .The imaging findings mainly included atelectasis （ 62%） .The mucous plugs were mainly distributed in the lower left lobe and right lobe , and the bronchial cast could be removed by bronchial endoscopy .Histological examination of the bronchial cast revealed that fibrinous material containing large quantity of inflammatory cells .Bronchial bronchoscopy and bronchial lavage were performed in 47 ca-ses, and 44 cases （93.6%） were successful .16 cases were detected 2 times or more than 2 times by bronchial en-doscopy.The cases with clinical improvement or recovery was 43.3 cases recurred and 4 cases died （8.0%）.Con-clusion Plastic bronchitis is a rare pediatric critical disease , and its clinical manifestations lack specificity , which can be easily misdiagnosed and missed diagnosis and has high mortality .Children with rapid and progressive respira-tory distress with lung atelectasis , pleural effusion or consolidation on chest radiograph should be considered .Bron-chial endoscopy is the most effective method for treatment of PB .