儿童气管性支气管50例临床分析  

Clinical analysis of 50 cases of tracheal bronchus in children

作　　者：陈奇洪 陈莉莉[1] 林丽华 张宁[1] 杨运刚[1] Chen Qihong;Chen Lili;Lin Lihua;Zhang Ning;Yang Yungang(Department of Pediatrics,the First Affiliated Hospital of Xiamen University,Xiamen Municipal Pediatric Quality Control Center,Xiamen 361003,China)

机构地区：[1]厦门大学附属第一医院儿科、厦门市儿科质控中心,厦门361003

出　　处：《中华全科医师杂志》2023年第6期626-628,共3页Chinese Journal of General Practitioners

基　　金：福建省自然科学基金项目(2020J011232)。

摘　　要：为分析气管性支气管患儿的临床特点,回顾性收集2017年7月至2021年9月厦门大学附属第一医院儿科因肺部感染、咳喘等病因行支气管镜介入确诊为气管性支气管患儿的临床资料,包括性别、年龄、症状、体征、支气管镜下表现、影像学表现、伴随疾病、转归等。总计50例患儿,男性35例,女性15例,中位年龄为11.3月龄,最小年龄为9 d,最大年龄为10岁。行支气管镜诊疗的病因中,重症肺炎26例(52%),反复喘息14例(28%),反复咳嗽8例(16%),异物2例(4%);临床症状以咳嗽45例(90%)、咳痰37例(74%)、气喘28例(56%)、发热25例(50%)为主,体征以湿啰音33例(66%)、干啰音24例(48%)、气促23例(46%)、三凹征21例(42%)为主;气管性支气管的发生部位均为气管下段右侧壁;50例患儿均行肺部影像学检查,仅有3例(6%)报告指出存在气管性支气管;有24例(48%)患儿伴有其他类型的气管畸形,包括单一软化9例(18%),单一气管狭窄6例(12%),气管外压1例(2%),余有8例(16%)合并多发气管畸形;27例(54%)存在不同类型的基础疾病,以先天性心脏病最为常见17例(34%),早产儿9例(18%),此外,染色体疾病、食道闭锁及气管食管瘘、多指畸形各3例(6%);所有患儿经抗感染及经支气管镜肺泡灌洗等治疗后均好转出院。提示气管性支气管作为一种气管先天畸形,不仅可引起感染,而且可伴随如气管软化、狭窄等其他气管畸形。The clinical data of 50 children with tracheal bronchus,35 males and 15 females with a mean age of 1.3 months(9 days to 10 years),diagnosed by bronchoscopy in the First Affiliated Hospital of Xiamen University from July 2017 to September 2021 were collected,including gender,age,symptoms,signs,bronchoscopy manifestations,imaging manifestations,associated diseases,and outcomes.There were 26 cases(52%)of severe pneumonia,14 cases(28%)of recurrent wheezing,8 cases(16%)of recurrent cough,and 2 cases(4%)of foreign bodies.The clinical symptoms were cough in 45 cases(90%),phlegm in 37 cases(74%),asthma in 28 cases(56%),and fever in 25 cases(50%).The physical signs were wet rale in 33 cases(66%),dry rale in 24 cases(48%),shortness of breath in 23 cases(46%),and triple concave sign in 21 cases(42%).The site of occurrence of tracheal bronchi was the right wall of the lower segment of the trachea.All 50 patients underwent complete pulmonary imaging examinations,but the presence of tracheal bronchus was reported in only 3 cases(6%).There were 24 cases(48%)with other types of tracheal malformations,including 9 cases(18%)of single malacia,6 cases(12%)of single tracheal stenosis,1 case(2%)of external tracheal compression,and 8 cases(16%)of multiple tracheal malformations.There were other underlying diseases in 27 cases(54%),congenital heart disease was the most common(17 cases,34%),followed by premature infants(9 cases,18%).In addition,there were 3 cases(6%)of chromosomal diseases,esophageal atresia,tracheoesophageal fistula,and polydactyly.All children were discharged after anti-infection and bronchoscopy alveolar lavage.It is suggested that tracheobronchial malformation can cause infection,as well as other tracheal deformities such as tracheal softening and stenosis.

关 键 词：支气管镜检查 儿童 气管性支气管 

分 类 号：R725.6[医药卫生—儿科]