16例儿童塑型性支气管炎临床特征分析

Clinical Characteristics of 16 Children with Plastic Bronchitis

目的分析儿童塑型性支气管炎临床特点,为儿童塑型性支气管炎的临床诊治提供参考。方法回顾性分析我院2013年1月至2020年12月确诊为塑型性支气管炎的16例患儿的临床表现、辅助检查、治疗及转归等信息,应用描述性方法进行临床特征分析。结果经纤维电子支气管镜检查确诊16例患儿,其中男女比例为3∶1,平均发病年龄(4.35±3.16)岁,15例患儿以中高热、咳嗽为主要表现,热程中位数6(3,12)d,可伴有气喘、胸痛及呼吸困难;血常规大多正常,CRP和PCT仅少数轻度增高;胸部影像学主要为肺不张伴代偿性肺气肿,可伴肺炎、纵膈及皮下积气、胸腔积液等,感染是主要病因,以肺炎支原体多见,其次为流感病毒。行纤维支气管镜检查出并取出支气管塑型,15例患儿予抗感染等对症支持治疗,所有患儿均临床治愈或好转出院,平均住院9.5(7.0,12.8)d,其中2例遗留闭塞性细支气管炎和闭塞性支气管炎。结论儿童塑型性支气管炎以反复的中高度发热、咳嗽、呼吸困难为主要表现,以肺炎支原体感染较为多见,血常规和炎症指标无特异性,肺部影像学检查有节段性肺不张、肺实变、积气等表现,及时行纤维支气管镜检查是诊断和治疗PB的有效方法,本病大多预后良好,少数患儿遗留闭塞性支气管炎和细支气管炎。

Objective To analyze clinical characteristics of children's plastic bronchitis(PB),hoping to provide reference for clinical diagnosis and treatment of PB.Methods From January 2013 to December 2020,clinical data of 16 children diagnosed with PB in our Hospital were analyzed retrospectively,including general materials,clinical manifestations,auxiliary examinations,treatment regimens and prognosis.Results 16 children were diagnosed by fiberoptic bronchoscopy.Ratio of male-to-female was 3∶1,mean age of onset was(4.35±3.16)years,15 patients were mainly characterized by moderate to high fever and cough,median of fever course was 6(3,12)days,accompanied by asthma,chest pain and dyspnea.Blood routine was mostly normal,CRP and PCT were only elevated slightly.Chest CT mainly showed atelectasis with compensatory emphysema,pneumonia,mediastinum and subcutaneous pneumatosis,pleural effusion,etc.Infection was the main cause that mycoplasma pneumoniae(MP)was the most common followed by flu virus.Bronchoscopy-assisted intervention was performed to take out bronchial cast formation.15 patients were given antibiotic treatment and other supportive treatment.All patients were clinically cured or improved and discharged with a mean duration of hospitalization of 9.5(7.0,12.8)days.2 cases were left with occlusive bronchiolitis obliterans and bronchitis obliterans.Conclusion Main clinical features of PB are recurrent medium to high fever,cough and dyspnea,combined with segmental atelectasis,pulmonary consolidation,pneumatosis in pulmonary imaging.MP is a common pathogen,but blood routine tests and inflammatory markers have no specificity.Fiberoptic bronchoscopy is an effective method for diagnosis and treatment of PB.Most patients have a good prognosis except a few patients have occlusive bronchiolitis obliterans and bronchitis obliterans.