儿童塑型性支气管炎39例临床分析

Clinical profiles of plastic bronchitis in children in a 39 case series

目的:分析儿童塑型性支气管炎临床资料以提高对该疾病的认识。方法:回顾性分析2011年1月至2018年12月广州医科大学附属第一医院收治的39例塑型性支气管炎患儿的临床表现、实验室检查、胸部影像学、治疗及预后等临床资料。结果:39例患儿中,男24例,女15例,平均年龄(5.2±3.3)岁,合并基础病15例(38.5%),病程中位数为11.0 d。咳嗽(100%)、发热(69.2%)、突发气促(53.8%)为最常见的症状,肺部湿罗音(71.8%)、鼻翼煽动(61.5%)、三凹征(56.4%)为最常见的体征。呼吸道病原学检测阳性30例(76.9%),以多重感染、病毒感染多见。胸部影像学显示病变多以单侧肺受累(64.1%),最常表现为斑片渗出(76.9%),其次为肺不张(69.2%)。所有患儿均经支气管镜介入治疗,其中24例(61.5%)需行多次介入治疗,接受呼吸机辅助通气、丙种球蛋白及全身激素的患儿比例分别为20.5%、38.5%、51.3%。最终38例好转,1例死亡。除了无基础病患儿的病毒检测阳性率高于合并基础病者(P<0.05),两组患儿其余的临床特征及治疗预后比较差异均无统计学意义(P>0.05)。结论:儿童塑型性支气管炎的临床表现非特异,若患儿较短时间内出现顽固性通气功能障碍且伴有肺不张或肺实变则应考虑本病,早期行支气管镜介入术是明确诊断、改善预后的关键。

Objective:To summarize on the clinical data of plastic bronchitis in children and to improve understanding of the disease.Methods:Data on clinical manifestations,laboratory findings,chest imaging,treatment and prognosis of 39 children with plastic bronchitis admitted to First Affiliated Hospital of Guangzhou Medica University between January 2011 and December 2018 were reviewed.Results:Among the 39 children,24 were boys and 15 were girls,with an age of(5.2±3.3)years old.Fifteen children(38.5%)had underlying conditons.The median duration of the disease was 11.0 days.Cough(100%),fever(69.2%),sudden shortness of breath(53.8%)were the most common symptoms;pulmonary wet rales lungs(71.8%),nasal agitation(61.5%),and three⁃concave sign(56.4%)were the most common signs.Thirty children(76.9%)tested positive for respiratory tract pathogens.Multiple infections and viral infections were predominant.Chest imaging studies showed that the lung lesions were largely unilateral(64.1%),and the most frequent signs included patchy exudation(76.9%),followed by atelectasis(69.2%).All children underwent interventional bronchoscopy,of which,24 cases(61.5%)required multiple sessions.The proportions of children receiving ventilator⁃assisted ventilation,use of gamma globulin and systemic steroids were 20.5%,38.5%,and 51.3%,respectively.Finally,38 patients improved and one died.Except for higher positivity of viral detection in children without than in those with underlying condition,(P<0.05),there was no significant differences in the other clinical profiles and treatment outcomes between these two subsets of patients(P>0.05).Conclusion:The clinical manifestations of plastic bronchitis in children are non⁃specific.Refractory ventilatory dysfunction in a fairly short duration of time,accompanied by atelectasis or pulmonary consolidation,should prompt for alert to this disease.Early intervention under bronchoscopy is the key to secure the diagnosis and improve the prognosis.