儿童慢性化脓性肺疾病的临床诊治分析  

Diagnosis and treatment of chronic suppurative lung disease in children

作　　者：胡次浪[1] 陈强[1] 李岚[1] 张帆[1] 章高平[1] 朱晓华[1] 吴爱民[1] 李建[1] Hu Cilang;Chen Qiang;Li Lan;Zhang Fan;Zhang Gaoping;Zhu Xiaohua;Wu Aimin;Li Jian(Department of Respiratory Medicine,Jiangxi Provincial Children′s Hospital,Nanchang 330006,China)

机构地区：[1]江西省儿童医院呼吸内科,南昌330006

出　　处：《中国小儿急救医学》2021年第5期397-400,共4页Chinese Pediatric Emergency Medicine

基　　金：江西省科技厅重点研发项目(20177BBG70020)。

摘　　要：目的分析儿童慢性化脓性肺疾病(chronic suppurative lung disease,CSLD)的病因及临床特征。方法回顾性分析2018年9月至2020年2月我院收治的CSLD患儿原发疾病、影像学改变、电子纤维支气管镜下改变、血气分析、肺功能、治疗转归等临床资料。结果共收集14例CSLD患儿,其中男6例,女8例,年龄(5.9±2.7)岁。14例CSLD患儿中,6例合并诊断上气道咳嗽综合征,3例合并诊断上气道咳嗽综合征并支气管哮喘,2例合并诊断咳嗽变异性哮喘,1例合并诊断联合性免疫缺陷病。电子纤维支气管镜下存在不同程度化脓性改变,3例合并气道炎性狭窄,支气管肺泡灌洗液提示中性粒细胞性炎症。血气分析10例正常,4例低氧血症。7例肺功能检查6例异常,1例肺CT检查存在肺气肿。予静脉应用抗生素序贯口服抗生素治疗后,14例患儿症状均缓解。随访12周,其中12例临床症状完全缓解,1例联合免疫缺陷病患儿咳嗽有反复,1例失访。结论CSLD患儿多存在原发病。电子纤维支气管镜既是CSLD必要的检查,也是治疗的重要手段。气道化脓性炎症可导致阻塞性肺功能异常。足疗程、规范使用抗生素是治疗CSLD的关键。Objective To analyze the causes and clinical features of chronic suppurative lung disease(CSLD)in children.Methods We retrospectivly analyzed the primary disease,imaging changes,electronic fiber bronchoscope changes,blood gas analysis,lung function,treatment outcome and other clinical data of CSLD in children hospitalized in our hospital from September 2018 to February 2020.Results A total of 14 children with CSLD were collected,including six males and eight females,aged(5.9±2.7)years old.Among 14 cases of CSLD,six cases were diagnosed with upper airway cough syndrome,three cases with upper airway cough syndrome and bronchial asthma,two cases with cough variant asthma,and one case with combined immunodeficiency disease.There were different degrees of purulent inflammation under electronic fiber bronchoscopy,and three cases had airway inflammatory stenosis.The lavage fluid suggested neutrophil inflammation.Blood gas analysis was normal in ten cases and hypoxemia in four cases.In seven cases,pulmonary function examination was abnormal in six cases,and one case had emphysema on lung CT examination.After intravenous administration of antibiotics and sequential oral antibiotics,the symptoms of 14 children were relieved.Fourteen cases were followed up for 12 weeks.Among them,12 cases had complete relief of clinical symptoms,one case had repeated cough with combined immunodeficiency disease,and one case was lost to follow-up.Conclusion CSLD mostly has primary disease.Electronic fiber bronchoscopy is not only a necessary examination of CSLD,but also one of the important means for treatment.Purulent inflammation of the airways can lead to abnormal obstructive lung.Sufficient course of treatment and standardized use of antibiotics are the key to the treatment for CSLD.

关 键 词：慢性化脓性肺疾病 儿童 湿性咳嗽 

分 类 号：R725.6[医药卫生—儿科]