儿童塑型性支气管炎误诊临床分析  

Clinical Analysis of Misdiagnosis for Children with Plastic Bronchitis

作　　者：王业军[1] 黄咏梅[2] WANG Ye-jun HUANG Yong-mei(Emergency Department, Women and Children＇s Hospital of Qingdao Affiliated to Medical College of Qingdao University, Qingdao, Shandong 266000, China Department of Otorhinolaryngology, People＇s Hospital of Rizhao, Rizhao, Shandong 276826, China)

机构地区：[1]青岛大学医学院附属青岛妇女儿童医院急诊科,山东青岛266000 [2]日照市人民医院耳鼻喉科,山东日照276826

出　　处：《临床误诊误治》2016年第12期10-12,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨儿童塑型性支气管炎(plastic bronchitis,PB)的临床特点及误诊原因。方法回顾性分析我院2014年1月—2016年1月收治的曾误诊为其他疾病的8例PB的临床资料。结果本组均因发热、咳嗽等症状就诊,且首诊均误诊,误诊为支气管异物5例,肺炎3例。查血白细胞正常、升高各3例,减少2例;血小板正常4例,升高3例,减少1例;血红蛋白正常5例,减少3例。病原体检查示肺炎支原体抗体阳性5例,细菌感染5例。X线胸片、胸部CT检查均显示肺炎征象;支气管镜检查见单侧支气管黏液阻塞。后均行支气管镜检查确诊为塑型性支气管炎,并在镜下将痰栓取出,术后痊愈出院,预后良好。结论儿童塑型性支气管炎症状及影像学检查无特异性,易误诊,早期支气管镜检查是提高诊断准确率及减少误诊的关键。Objective To investigate clinical features and misdiagnosed causes of children with plastic bronchitis （ PB） . Methods Clinical data of 8 children with PB, who had been misdiagnosed as having other diseases between January 2014 and January 2016, was retrospectively analyzed. Results All the patients visited doctors for fever and cough, and ini-tial diagnoses were all misdiagnosed, in whom 5 patients were misdiagnosed as having foreign body of bronchus and 3 patients as having pneumonia. Examination showed that there were 3 patients with normal white blood cells, 3 patients with elevated white blood cells and 2 patients with leukopenia;there were 4 patients with normal platelet, 3 patients with increased platelet and 1 patient with decreased platelet;there were 5 patients with normal hemoglobin and 3 patients with decreased hemoglobin. Pathogen examination showed 5 patients with positive mycoplasma pneumoniae antibody and 5 patients with bacterial infection. Chest X-ray and chest CT scan showed pneumonia signs. Bronchoscopy showed unilateral bronchial mucus obstruction, and PB was confirmed. All patients underwent removal of foreign body under fiber bronchoscope, and were discharged after cure with good prognoses. Conclusion Children with plastic bronchitis have no specificity of symptoms and imaging features, so it is easy to be misdiagnosed. Early bronchoscopy is the key to improve the diagnostic accurate rate and decrease misdiagnosis.

关 键 词：支气管炎 儿童 误诊 异物 肺炎 支气管镜检查 

分 类 号：R725.6[医药卫生—儿科]