儿童塑型性支气管炎早期预警分析及可弯曲支气管镜治疗的临床研究  

Early warning analysis of plastic bronchitis in children and clinical study of flexible bronchoscopy

作　　者：王琦 靳蓉[2] 陈敏[2] 韩冰 谢汝佳 孙永烽 程星[2] 吴炜[2] 杨勤 Wang Qi;Jin Rong;Chen Min;Han Bing;Xie Rujia;Sun Yongfeng;Cheng Xing;Wu Wei;Yang Qin(Department of Pathophysiology,School of Basic Medicine,Guizhou Medical University,Guiyang 550004,China;Department of Respiratory Medicine,Guiyang Maternal and Child Health Hospital,Guiyang 550003,China)

机构地区：[1]贵州医科大学基础医学院病理生理学教研室,贵阳550004 [2]贵阳市妇幼保健院呼吸科,贵阳550003

出　　处：《中华实用儿科临床杂志》2022年第23期1786-1792,共7页Chinese Journal of Applied Clinical Pediatrics

基　　金：贵州省科技厅社会发展课题经费项目(黔科合支撑(2020)4Y123号);贵州省卫健委科学技术基金项目(gzwkj2021-289)。

摘　　要：目的研究儿童塑型性支气管炎的临床特征及病原学分布特点并分析其早期预警指标,评估可弯曲支气管镜的临床诊治效果。方法回顾性分析2019年1月至2021年2月贵阳市妇幼保健院收治的232例重症肺炎患儿的临床资料,根据支气管镜下表现分为塑型性支气管炎组(塑型组)和非塑型性支气管炎组(非塑型组),并收集患儿性别、年龄、临床表现、辅助检查、影像学特征、支气管镜所见和治疗情况并进行比较分析,组间比较采用t检验或χ^(2)检验。结果本研究共纳入232例患儿,其中塑型组98例,非塑型组134例,两组患儿均以发热、咳嗽、气促为主要表现,塑型组发病年龄(54.640±37.085)个月,非塑型组发病年龄(14.870±19.813)个月,两组发病年龄比较差异有统计学意义(t=9.656,P<0.001);塑型组平均住院天数(16.133±6.227)d,非塑型组平均住院天数(12.690±4.287)d,两组住院天数比较差异有统计学意义(t=4.721,P<0.001);塑型组发热天数(10.090±3.473)d,非塑型组发热天数(6.030±4.850)d,两组发热天数比较差异有统计学意义(t=5.654,P<0.001);塑型组发病年龄、住院天数、发热天数均大于非塑型组(均P<0.001);塑型组体格检查呼吸音减低40%(39/98)明显高于非塑型组6%(8/134);塑型组血氧分压(PO2)、血氧饱和度(SO2)均低于非塑型组(均P<0.01);塑型组中性粒细胞比例(N)、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)、D二聚体均高于非塑型组(均P<0.01);塑型组影像学肺实变73%(72/98)、肺不张33%(32/98)、胸腔积液34%(33/98);非塑型组肺实变65%(87/134)、肺不张5%(7/134)、胸腔积液3.7%(5/134);塑型组患儿检出首要病原为肺炎支原体(MP)(46.9%),明显高于非塑型组(11.1%);两组患儿入院均行可弯曲支气管镜检查,塑型组(2.960±1.157)次,非塑型组(1.140±0.371)次;塑型组98例患儿中95例均好转出院,2例转院,1例死亡,非塑型组134例患儿均好转出院。结论临床上�Objective To study the clinical characteristics and etiological distribution characteristics of plastic bronchitis in children,analyze its early warning indicators,and evaluate the clinical diagnosis and treatment effect of flexible bronchoscopy.Methods The clinical data of 232 children with severe pneumonia admitted to Guiyang Maternal and Child Health Hospital from January 2019 to February 2021 were retrospectively analyzed.The children were divided into the plastic bronchitis group and non-plastic bronchitis group according to bronchoscopic results.The gender,age,clinical manifestations,auxiliary examinations,imaging features,bronchoscopy findings and treatment of the children were collected,compared and analyzed,comparison between two groups by t test andχ^(2) test.Results A total of 232 children were included in this study,including 98 cases in the plastic bronchitis group and 134 cases in the non-plastic bronchitis group.The main symptoms of both groups were fever,cough and shortness of breath.The age of onset in the plastic bronchitis group was(54.640±37.085)months,and the age of onset in the non-plastic bronchitis group was(14.870±19.813)months.The difference in the age of onset between the two groups was statistically significant(t=9.656,P<0.001).The average hospitalization days of the plastic and non-plastic bronchitis groups were(16.133±6.227)d and(12.690±4.287)d,respectively.Significant difference was found in the average hospitalization days between the two groups(t=4.721,P<0.001).The average fever days of the plastic bronchitis group were(10.090±3.473)d,and the average fever days of the non-plastic bronchitis group were(6.030±4.850)d.There was significant difference in the average fever days between the two groups(t=5.654,P<0.001).The age of onset,hospitalization days,and fever days of the plastic bronchitis group were larger than those of the non-plastic bronchitis group(all P<0.001).The physical examination suggested that 40%(39/98)of patients in the plastic bronchitis group had reduced the

关 键 词：儿童 塑型性支气管炎 可弯曲支气管镜 介入治疗 

分 类 号：R725.6[医药卫生—儿科]