儿童原发塑型性支气管炎的临床及影像学分析

Clinical and Imaging Analysis of Primary Plastic Bronchitis in Children

目的探析儿童原发塑型性支气管炎的临床及影像学特点。方法回顾性分析2015年1月-2017年12月我院确诊为原发塑型性支气管炎患儿27例,统计患者基本资料、临床症状、实验室检查结果、纤维支气管镜检查特征及CT影像学资料,总结分析原发塑型性支气管炎的临床及影像学特点。结果患者均伴有不同程度的咳嗽、高热、气促、进行性呼吸困难等症状;金黄色葡萄球菌感染7例,肺炎支原体感染者19例,腺病毒抗原检测阳性者5例,白假丝酵母菌感染者2例,混合感染者8例;血常规、血清生化检查主要表现为白细胞计数升高,血沉增快;塑型黏液栓病理学镜下呈纤维素样改变,可见大量中性粒细胞及淋巴细胞等炎性细胞浸润;胸部CT呈肺部感染、肺实变征象,示支气管部分或完全阻塞,节段性肺不张5例,胸腔积液者9例,包裹性气胸2例,支气管黏液嵌塞症10例,累及胸膜病变者4例。患儿均行纤支镜取出塑型黏液栓并反复灌洗支气管,同时予以祛痰、抗感染、免疫支持治疗后,患儿呼吸功能均明显恢复,病情显著改善。结论根据临床表现疑诊为原发塑型性支气管炎的患儿,均应及时采用胸部CT与病理学检查进行诊断,予以支持对症治疗的基础上早期行纤维支气管镜取出内生异物以解除呼吸阻塞,降低患儿死亡风险。

Objective To explore the clinical and imaging features of primary plastic bronchitis in children. Methods A retrospective analysis was performed on 27 children with primary plastic bronchitis diagnosed in the hospital during the period from January2015 to December 2017. The general data, clinical symptoms, laboratory examination results, features of fiberoptic bronchoscopy and CT images were statistically analyzed. The clinical and imaging features of primary bronchitis were summarized and analyzed. Results All patients had different degrees of symptoms such as cough, high fever, shortness of breath and progressive dyspnea. There were 7 cases with Staphylococcus aureus infection,19 cases with Mycoplasma pneumoniae infection, 5 cases with positive adenovirus antigen,2 cases with Candida albicans infection and 8 cases with mixed infection. Blood routine and serum biochemical tests mainly showed elevated white blood cell count and increased erythrocyte sedimentation rate(ESR). Plastic mucus plugs showed fibrinoid changes under pathological microscope, showing large number of neutrophils and lymphocytes and other inflammatory cell infiltration. Chest CT showed lung infection, lung consolidation signs,partial or complete obstruction of the bronchus, segmental pulmonary atelectasis in 5 cases,pleural effusion in 9 cases, parcel pneumothorax in 2 cases, bronchial mucous impaction in 10 cases and pleural lesions in 4 cases. Plastic mucus plugs in all children were removed under bronchofiberscope and the bronchus was rinsed repeatedly. The respiratory function of children was significantly restored after sputum-removal, anti-infection and immune supportive therapies, and the condition was significantly improved. Conclusion For children with suspected primary plastic bronchitis, chest CT and pathological examination should be used for diagnosis in time. Supportive symptomatic treatment combined with early removal of endogenous foreign body under bronchofiberscope can relieve respiratory obstruction and reduce the risk of death.