儿童塑型性支气管炎的临床特征分析

Analysis of Clinical Features of Children's Plastic Bronchitis

目的探讨塑型性支气管炎(PB)的临床特点,提高临床医生对儿童PB的认识。方法选择佛山市妇幼保健院2014年5月~2019年8月收治的39例PB患儿作为研究对象,分析其临床表现、实验室、影像学和支气管镜检查以及治疗经过、转归等。结果患儿均有发热和咳嗽,34例(87.18%)为高热(体温峰值≥39.1℃),29例(74.36%)发热天数≥1周。33例(84.62%)患儿外周血C反应蛋白(CRP)升高,26例(66.67%)降钙素原(PCT)升高,16例(41.03%)血沉(ESR)增快。37例患儿肺CT表现以大片实变为主,2例以肺不张为主,18例合并胸腔积液,另外2例肺不张为主的患儿支气管镜显示存在异物。6例行3次支气管镜检查中,2例(33.33%)应用机械通气治疗。全部病例均以好转或治愈出院,平均住院12.8 d。结论塑型性支气管炎患儿临床表现为高热、咳嗽、呼吸增快,肺部影像学出现肺大片实变、肺不张、胸腔积液,血液检查提示CRP、PCT、ESR升高,常规抗感染治疗效果欠佳,另外,支气管异物亦可导致PB,建议及时行支气管镜检查明确病因。

Objective To explore the clinical characteristics of plastic bronchitis(PB)and to improve clinicians'understanding of children with PB.Methods A total of 39 children with PB admitted to Foshan Maternity and Child Health Hospital from May 2014 to August 2019 were selected as the research subjects to analyze their clinical manifestations,laboratory,imaging,bronchoscopy,treatment history,and outcome.Results All children had fever and cough.34 cases(87.18%)had high fever(peak temperature≥39.1℃),and 29 cases(74.36%)had fever≥1 week.33 children(84.62%)had increased peripheral blood C-reactive protein(CRP),26(66.67%)had increased procalcitonin(PCT),and 16(41.03%)had increased erythrocyte sedimentation rate(ESR).37 patients with lung CT showed large-scale consolidation,2 patients with atelectasis,18 patients with pleural effusion,and the other 2 patients with atelectasis showed the presence of foreign bodies on bronchoscopy.Among 6 cases underwent 3 bronchoscopy,2 cases(33.33%)were treated with mechanical ventilation.All cases were discharged from the hospital with improvement or cure,with an average hospital stay of 12.8 d.Conclusion The clinical manifestations of children with plastic bronchitis are high fever,cough,and rapid breathing.Large-scale lung consolidation,atelectasis,and pleural effusion appear in lung imaging.Blood tests indicate elevated CRP,PCT,and ESR.Infection treatment is not effective.In addition,bronchial foreign bodies can also cause PB.It is recommended to perform bronchoscopy in time to determine the cause.