儿童腺病毒肺炎并塑型性支气管炎9例临床分析  

Clinical analysis of plastic bronchitis caused by adenoviral pneumonia in 9 children

作　　者：黄晶晶[1] 袁林[1] 卓志强[1] 朱其国 李明珍 Huang Jingjing;Yuan Lin;Zhuo Zhiqiang;Zhu Qiguo;Li Mingzhen(Third Ward,Xiamen Children′s Hospital(Children′s Hospital of Fudan University Xiamen Branch),Key Laboratory of Neonatal Diseases in Xiamen,Xiamen 361006,Fujian Province,China)

机构地区：[1]厦门市儿童医院(复旦大学附属儿科医院厦门分院)三病区,厦门市新生儿疾病重点实验室,361006

出　　处：《中华实用儿科临床杂志》2020年第16期1260-1263,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：厦门市科技局科技惠民项目(3502Z20164069)。

摘　　要：目的分析腺病毒肺炎引起塑型性支气管炎(PB)的临床特点。方法回顾性分析2019年3月至6月在厦门市儿童医院确诊的9例腺病毒肺炎并PB患儿的临床资料。结果9例患儿中男3例,女6例,2岁以下6例,均有发热、咳嗽、呼吸急促,热程6~15 d;降钙素原(PCT)升高7例,D-二聚体、纤维蛋白原降解物(FDP)升高6例,乳酸脱氢酶(LDH)升高8例;9例均伴肺实变不张,其中左下肺实变不张4例,右肺下叶2例,右肺上叶1例,两肺下叶多发实变不张2例,7例并胸腔积液。病程第6-20天经纤维支气管镜取出支气管塑型物,左肺下叶5例,右肺下叶3例,右肺上叶1例。8例临床治愈后出院,1例出现多脏器功能衰竭,家属放弃抢救,自动出院,电话随访死亡。结论腺病毒肺炎伴持续高热、呼吸急促、呼吸困难、肺实变/肺不张,PCT、LDH升高、血液高凝、并胸腔积液等,需警惕并PB,纤维支气管镜对明确诊断、改善临床症状及预后至关重要。Objective To analyze the clinical characteristics of plastic bronchitis(PB)caused by adenoviral pneumonia.Methods The clinical data of 9 children diagnosed with PB caused by adenoviral pneumonia in the Xiamen Children′s Hospital from March to June 2019 were retrospectively analyzed.Results Among the 9 children(3 boys and 6 girls),6 patients were under 2 years old.All patients had fever,cough and dyspnea,with the duration of 6-15 days.Laboratory tests showed that procalcitonin(PCT)and increased in 7 children,D-dimer,fibrinogen degraded product(FDP)were increased in 6 children,and lactate dehydrogenase(LDH)was increased in 8 children.Chest imaging examination showed atelectasis with pulmonary consolidation in 9 children,including 4 cases of left lower lobe consolidation,2 cases of right lower lobe consolidation,1 case of right upper lung consolidation,and 2 cases of consolidation of multiple lungs in the lower lobe.Seven cases had pleural effusion.By fiberoptic bronchoscopy,the bronchial plastics was removed from the left lower lobe in 5 patients,from the right lower lobe in 3 patients,and from the right upper lobe in 1 patient on the 6th to 20th day of the disease.Eight patients were discharged after clinical cure.One patient deve-loped multiple organ failure,and discharged from the hospital after the family members gave up rescue.The death was reported by the telephone follow-up death.Conclusions PB is considered when patients with adenovirus pneumonia have persistent high fever,shortness of breath,dyspnea,pulmonary consolidation/lung atelectasis,increased PCT and LDH,hypercoagulability of the blood,and pleural effusion.Fiberoptic bronchoscopy plays an important role in confirming the diagnosis and improving the prognosis.

关 键 词：腺病毒 塑型性支气管炎 纤维支气管镜 儿童 

分 类 号：R725.6[医药卫生—儿科]