成人纤维素性支气管炎并大咯血诊治分析  

Analysis about diagnosis and treatment of paistic bronchitis with massive hemoptysis in adults

作　　者：邹欣[1] 马志益[1] 梁荣章[1] 翁端丽[1] 

机构地区：[1]福建省龙岩市第一医院福建医科大学附属龙岩第一医院呼吸内科,364000

出　　处：《国际呼吸杂志》2015年第16期1230-1234,共5页International Journal of Respiration

摘　　要：目的探讨纤维素性支气管炎并大咯血临床诊治过程，提高对成人纤维素性支气管炎的认识和诊治水平。方法结合我院2014年1月以来2例经病理证实的成人纤维素性支气管炎并大咯血患者的临床资料与国内外有关文献，对成人纤维素性支气管炎的病因学、病理、发病机制及诊治过程进行分析。结果成人纤维素性支气管炎临床上是以周期性或顽固地咯血、咳嗽、咯出或支气管镜检出支气管管型为特点的疾病，大多数继发于心肺基础疾病，其发病机制目前尚不完全清楚，考虑与气道变态反应有关，主要靠咯出物或气管镜下取出物病理确诊，一旦确诊可积极糖皮质激素抗炎辅以止血等对症治疗，同时注重原发病治疗。结论成人纤维素性支气管炎诊断首先靠患者临床表现，放射影像联合支气管镜检查可提高诊断率，糖皮质激素治疗成人纤维素性支气管炎尤其合并大咯血患者效果好。Objective To investigate the clinical diagnosis and treatment of plastic bronchitis （PB） with massive hemoptysis, in order to improve the identification and trentment of the disease in adults. Methods Two adult PB cases with massive hemoptysis identified by pathology in our hospital were retrospectively reviewed. The etiology, pathology, pathogenesis, diagnosis and treatment of PB in adults were analyzed with relevant internal or outside literatures. Results PB in adults is a rare disorder characterized as hemoptysia periodically or persistently, severe cough, and endobronchial casts expectorated or removed by bronchoscopy. It is often associated with variable cardiorespiratory diseases, the pathogenesis is still unkown, which may be related to airway allergy. A definite diagnosis is usually made when expectorated or removed endobronchial casts are checked by pathology. Once PB is identified, corticosteroids should be used preferentially in PB patients with hemoptysis, including symptomatic and etiological treatments. Conclusions The diagnosis o~ PB depends on the clinical manifestation of the patients importantly, radioexamination combined with bronchoscopy can improve the diagnosis rate of PB. Corticosteroids therapy has a good effect on PB in adults,especially on those with massive hemoptysis.

关 键 词：纤维素性支气管炎 诊断 治疗 糖皮质激素 咯血 

分 类 号：R562.21[医药卫生—呼吸系统]