儿童感染后闭塞性支气管炎152例临床分析  

Clinical analysis of 152 cases of post⁃infectious bronchiolitis obliterans in children

作　　者：朴美英[1] 张俐[1] 李春艳[1] 刘君辉 刘娜[1] 王立君[1] 孟繁峥[1] PIAO Meiying;ZHANG Li;LI Chunyan;LIU Junhui;LIU Na;WANG Lijun;MENG Fanzheng(Department of Pediatric Respiratory Medicine,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院小儿呼吸科,长春130021

出　　处：《中国临床新医学》2024年第11期1204-1209,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：吉林省科技发展计划项目(编号:20180311129YY)。

摘　　要：目的探讨儿童感染后闭塞性支气管炎的临床特点及预后,为其临床诊治提供参考。方法回顾性分析2015年1月至2023年12月吉林大学第一医院小儿呼吸科收治的152例感染后闭塞性支气管炎患儿的临床资料。比较有无喘息或特应性体质患者、是否应用全身糖皮质激素治疗患者的转归。结果152例患儿年龄17个月至17岁,以≥6岁为主(占69.74%)。临床表现无特异性,152例闭塞性支气管炎患儿均有不同程度反复咳嗽及发热,诊断闭塞性支气管炎中位时间为19(15.0,28.5)d。151例患儿病原学检测阳性,单一病原感染53例,混合感染98例。148例肺炎支原体阳性,病毒感染中腺病毒感染最多见。152例均行肺部CT检查,主要表现为实变、含气不良或肺不张、密度不均,胸腔积液、支气管扩张等。152例均探查到支气管、段支气管、近端亚段或其分支支气管闭塞。急性期可见管腔痰栓或黏液栓堵塞病变管腔(114例),塑型性支气管炎(10例),灌洗液呈米汤样、血性或较多脓性分泌物堵塞(38例),继而表现为病变气道黏膜不同程度出现坏死、苍白、糜烂、剥脱或溃疡、触之易出血(55例),支气管管腔软骨结构破坏,出现管腔软化、塌陷、走行扭曲、螺旋形及环形狭窄(98例),鱼骨刺样改变(2例)。在86例随访患者中,应用全身糖皮质激素组(69例)肺部影像学好转率为73.91%,高于未应用全身糖皮质激素组(17例)的52.94%,出现肺不张或含气不良、通气密度不均以及支气管扩张比例低于未应用全身糖皮质激素组,但差异无统计学意义(P>0.05)。无喘息或特应性体质组(66例)肺部影像学好转率为78.79%,高于有喘息或特应性体质组(20例)的40.00%,出现通气密度不均比例低于有喘息或特应性体质组,差异有统计学意义(P<0.05)。结论当患儿在临床上表现为反复发热、咳嗽,病程中出现喘息或有特应性体质者,早期支气管镜检查发现气道�Objective To explore the clinical characteristics and prognosis of post-infectious bronchiolitis obliterans in children,and to provide reference for its clinical diagnosis and treatment.Methods The clinical data of 152 pediatric patients with post-infectious bronchiolitis obliterans who were admitted to Department of Pediatric Respiratory Medicine,the First Hospital of Jilin University from January 2015 to December 2023 were retrospectively analyzed.The outcomes were compared between the patients with wheezing and the patients without wheezing,or between the patients with atopic constitution and the patients without atopic constitution.The outcomes were compared between the patients treated with systemic glucocorticoids and the patients treated with no systemic glucocorticoids.Results The age of the 152 pediatric patients ranged from 17 months to 17 years,and the age of the majority of the pediatric patients was equal to or more than 6 years(accounting for 69.74%).The clinical manifestations of the pediatric patients were non-specific.All the 152 pediatric patients with bronchiolitis obliterans had recurrent cough and fever in varying degrees.The median time for diagnosis of bronchiolitis obliterans was 19(15.0,28.5)days.A total of 151 pediatric patients tested positive for pathogens,with 53 cases of single pathogen infection and 98 cases of mixed pathogen infection.A total of 148 pediatric patients were positive for Mycoplasma pneumoniae,and adenovirus infection was the most common infection among the patients with viral infection.All the 152 pediatric patients underwent CT examination of the lungs,and the main findings of the CT examination were consolidation,poor gas content or atelectasis,uneven density,pleural effusion and bronchiectasis.Occlusions of bronchus,segmental bronchus,proximal subsegment or its branches were detected in all the 152 pediatric patients.In the acute stage,phlegm clots or mucus phlegm obstruction in the lumen were showed in 114 cases,plastic bronchitis in 10 cases,rice soup-like lavag

关 键 词：儿童 感染后闭塞性支气管炎 纤维支气管镜 危险因素 预后 

分 类 号：R725.6[医药卫生—儿科]