儿童塑形性支气管炎30例临床分析

Clinical analysis of 30 children with plastic bronchitis

目的探讨儿童塑形性支气管炎(PB)临床、病理特点以及治疗、转归。方法回顾性分析30例PB患儿的临床资料,分析临床表现、实验室检查、胸部影像学、呼吸道病原学检查、纤维支气管镜检查等特点,总结治疗、转归情况。结果 30例患儿均以发热咳嗽为主要临床表现,肺部X线均符合肺炎诊断,主要表现为肺实变、肺不张;病原菌主要为肺炎支原体。所有患儿均给予抗感染治疗,部分配合糖皮质激素治疗;均经纤维支气管镜术检查取出塑形样物,阻塞广泛患儿同时予组织型纤溶酶原激活剂灌注,病理分型均为Ⅰ型。21例行支气管镜术后48 h复查胸部影像好转,所有患儿出院前临床表现显示好转。结论及时行纤维支气管镜取出塑形物,在抗感染的同时给予激素治疗,有利于PB患儿预后。

Objective To investigate the clinical and pathological characteristics, treatment and outcome of children with plastic bronchitis（PB）. Methods Clinical data of 30 children with PB were retrospectively reviewed. The features of clinical manifestations, laboratory test, chest imaging, respiratory pathogen and bronchoscopy were analyzed, and the treatment and outcome were summarized. Results Among the 30 cases,the main clinical manifestations were fever and cough,all of the presentations of lung X-ray accorded with the diagnosis of pneumonia and the main presentations included consolidation and atelectasis. The main pathogen was mycoplasma pneumoniae. All cases were treated with antibiotics, and some children were administered glucocorticoid at the same time. Bronchial casts were removed by bronchoscopy in all cases, and the children with wide obstruction received bronchoalveolar lavage with tissue-type plasminogen activator. The pathological types of all bronchial casts were type I. Improvement of chest imaging was found in 21 cases after 48 hours of bronchoscopy, and the clinical manifestations of all cases improved before discharge. Conclusion Removing the bronchial casts by bronchoscopy timely and administration of glucocorticoid combined with antibiotics are benefit for the prognosis of children with PB.