儿童塑型性支气管炎9例临床特征及病原学分析

Clinical features and pathogens of plastic bronchitis in children：an analysis of 9 cases

摘要:

目的 探讨儿童塑型性支气管炎的临床特点及病原学分析。方法 回顾分析2011~2012 年9 例确诊为塑型性支气管炎患儿的临床资料，对其临床、影像、纤维支气管镜（纤支镜）特点、病原体及治疗进行总结。结果 9 例患儿均以高热、咳嗽起病，在发病1~3 d 出现呼吸困难，并进行性加重；一侧或双侧肺部呼吸音减低，肝脾肿大；合并呼吸衰竭6 例次、中毒性脑病6 例次、中毒性肝炎7 例次、休克3 例次、心力衰竭3 例次、肾功能衰竭2 例次。胸片或胸部CT 均表现为单个及多个肺叶段实变及不张， 4 例合并胸腔积液。纤支镜镜下均可见灰白色黏液栓堵塞支气管开口，吸出支气管样塑形物。9 例患儿均检出流感病毒（IFVs），以甲型流感病毒（IFV-A）为主（67%）。IFV-A 合并肺炎支原体及细菌的混合感染率为50%。3 例乙型流感病毒（IFV-B）感染患儿中，1 例合并肺炎支原体感染。9 例患儿均予抗感染、激素、丙种球蛋白及必要的呼吸支持治疗；均经纤支镜行内生异物取出及肺泡灌洗治疗；5 例予奥司他韦抗病毒治疗。痊愈7 例，死亡2 例。结论 儿童塑型性支气管炎临床与重症肺炎类似；流感病毒是其主要病原；治疗上除抗感染、糖皮质激素、丙种球蛋白、呼吸支持等常规治疗外，经纤支镜内生异物取出及早期奥司他韦抗病毒治疗可获得良好疗效。

Abstract:

Objective To study the clinical features and pathogens of plastic bronchitis in children. Methods A retrospective analysis was performed on the clinical data of 9 children who were diagnosed with plastic bronchitis between January 2011 and December 2012. Results Plastic bronchitis began with a fever and cough in all cases, followed by progressive dyspnea on days 1-3 of onset; unilateral or bilateral decreased breath sounds and hepatosplenomegaly were found; complications included respiratory failure (6 cases), toxic encephalopathy (6 cases), toxic hepatitis (7 cases), shock (3 cases), heart failure (3 cases), and renal failure (2 cases). Chest X-ray or chest CT showed single and multiple lobar or segmental consolidation and atelectasis, as well as pleural effusion (4 cases). The bronchofibroscopy revealed some grey-white mucus plugs that blocked bronchial openings and aspirates of bronchial shape. Influenza viruses (IFVs) were detected in all cases, including IFV-A (6 cases, 67%) and IFV-B (3 cases, 33%). Mixed infection with IFV-A and Mycoplasma pneumoniae (MP)/bacteria was found in 50% of all cases. In the three cases of IFV-B infection, one was complicated by MP infection. Nine patients were given treatment of antibiotics, hormones, gamma globulin and necessary respiratory support, and also were given removal of endogenous foreign body by bronchoscopy. Five patients were given antiviral therapy of oseltamivir. Seven cases cured, and 2 died. Conclusions Plastic bronchitis and severe pneumonia are similar in clinical manifestations. IFVs are the main pathogen. In addition to anti-infection treatment, hormone, gamma globulin, respiratory support, and other conventional treatments, endogenous foreign body removal by bronchofibroscopy and early antiviral therapy with oseltamivir have good efficacy.