闭塞性细支气管炎23例临床分析  

Clinical features of 23 cases of bronchilitis obliterans

作　　者：刘秀云[1] 江载芳[1] 彭云[2] 

机构地区：[1]首都医科大学附属北京儿童医院内科,北京100045 [2]首都医科大学附属北京儿童医院放射科,北京100045

出　　处：《中国实用儿科杂志》2008年第4期263-265,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的总结闭塞性细支气管炎(BO)的临床诊治经验。方法对2001年2月至2005年9月首都医科大学附属北京儿童医院临床诊断的23例BO的临床特点、影像学、治疗的转归进行了总结。结果23例中有3例为Stevens-Johnson综合征(SJS),20例均为重症肺炎后,其中2例为腺病毒肺炎后,3例为麻疹后肺炎。23例患儿均有咳嗽、喘息。19例有三凹征,4例有低氧血症,其中3例呼吸衰竭。肺功能示阻塞性通气障碍19例,混合性通气障碍4例。22例的肺CT结果为:肺通气不均22例,马赛克征21例,支气管壁增厚15例,支气管扩张17例,斑片影14例,黏液栓7例。22例做纤维支气管镜,均为气管支气管的慢性炎症,9例(40.8%)有通气不畅。15例进行了支气管肺泡灌洗液的细胞分析,结果为13例示中性粒细胞增高。2例嗜酸细胞大于0.02,但小于0.20。淋巴细胞均不高。随访无死亡。结论小儿BO以感染所致者最常见,临床以慢性咳嗽、喘鸣音为特点,肺CT以通气不均匀、马赛克征为特点,肺功能多示阻塞性通气障碍,治疗以激素为主。Objective To recognize the clinical features of the bronchiolitis obliterans.Methods Review 23 cases of bronchiolitis obliterans about clinical manifestation,chest X-ray,computed tomography（CT）and pulmonary function.Results Three cases were SJS;20 cases were severe pneumonia,including two cases of adenovirus pneumonia;three cases were severe pneumonia after measles.Cough and wheezing persisted in all patients.Nineteen patients were of retraction（intercostal,subcostal and suprasternal）,four cases were were with hypoxemia,including three cases with respiratory failure.The result of the lung function showed that 19 cases with obstructive airflow defect and 4 cases with mixed restrictive and obstructive dysfuntion.The computed tomography（CT）/high-resolution CT（HRCT）were taken in 22 cases.All 22 cases revealed the areas of the decreased density in the lung;the Mosaic pattern was seen in 21 patients;bronchial wall thickening was seen in 15 cases;14 cases were with patchy shadows,and mucus plugging were seen in 7 patients;bronchiectasis was seen in 17 cases.The fiberbronchoscopy was performed in 22 cases.The chronic inflammation of the airway was seen in all patients.The BALF was obtained in 15 patients.The cell of the BALF were as：the count of neutrophils in 13 cases were more than 10%,2 case with eosinophil more than 2%,but less than 20%.Lymphocytes were not high in all the cases.There was no death in our patients.Conclusion BO is the sequela of severe lung injury.Most cases are severe pneumonia.The chronic cough and wheezing are the main clinical manifestations.In pulmonary CT/high-resolution CT（HRCT）,the areas of the decreased density and Mosaic pattern are the most common signs.Lung function test shows the obstructive airflow defect in most patients.The corticosteroid is the main therapy in the treatment of the patient.

关 键 词：毛细支气管炎 闭塞性 肺功能 高分辨CT 

分 类 号：R72[医药卫生—儿科]