小儿危重症甲型流感并发塑型支气管炎15例临床分析
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Critical influenza A complicated with plastic bronchitis in children:15 cases report
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    摘要:

    目的:分析小儿危重症甲型流感并发塑型支气管炎(plastic bronchitis,PB)的诊治特点。方法:对2012年至2013年2年重庆儿童医院收治的15例危重症甲型流感并发PB的患儿的临床表现、支气管镜检查及吸出物的病理、治疗经过和转归进行回顾性分析。结果:本组15例甲流患儿均为危重症病例,急性起病,迅速出现呼吸衰竭,均行机械通气支持,从发病到应用机械通气平均(2.5±0.9) d;影像学大多早期由一叶肺或单肺实变不张迅速累及余肺(病程第2~3天);白细胞计数、C-反应蛋白(C-neactveprotein,CRP)、降钙素原(procalcitonin,PCT)等炎症指标大多数升高;所有患儿均使用纤支镜吸出白色胶冻样痰栓,其中11例呈支气管树样;治疗过程中患儿均有严重高碳酸血症、低氧血症,气胸4例,惊厥1例。所有患儿经纤支镜吸出胶冻样痰栓及呼吸机治疗后,病情明显改善,无死亡病例。结论:PB是一种潜在危及生命的疾病,危重症甲流患儿易并发PB。在甲流流行季节,临床上出现急性起病、短期内进行性呼吸困难,伴有肺不张或实变时,应想到本病,如果对常规治疗反应不佳,应尽早行纤支镜检查治疗。同时掌握好机械通气的指征及策略,减少相关并发症的发生。

    Abstract:

    Objective:To analyze the diagnosis and treatment characteristics of the critically illed children with influenza A virus in-fection complicated with plastic bronchitis(PB). Methods:A retrospective investigation on the clinical manifestations,bronchoscope results,histological results of the aspirate,clinical course and outcome of 15 children with plastic bronchitis associated with influenza A virus infection in the Children’s Hospital of Chongqing from 2012 to 2013 was conducted. Results:All 15 patients were critically ill children with acute onset,rapid respiratory failure and underwent mechanical ventilation from the onset to the average(2.5±0.9) d;most cases involved the remaining lung rapidly(on the 2nd-3rd d of the course) from atelectasis of single lung or lung lobe. Leuko-cyte count,C-neactveprotein,procalcitonin and other inflammatory markers elevated. White jelly-like sputum was sucked out from all patients by using bronchoscopy,of which 11 cases was bronchial tree-like. All children suffered from severe hypercapnia and hypoxia;4 cases suffered from pneumothorax and one case from convulsions during the treatment. All children’s condition improved signif-icantly and with no death after sucking out the jelly-like sputum by bronchoscopy and ventilator treatment. Conclusion:PB is a life-threatening disease and children with critical influenza A virus infection are the susceptive population. In the epidemic season of in-fluenza A virus,plastic bronchitis should be considered in children undergoing rapid and progressive respiratory distress with lung at-electasis or consolidation on chest radiograph. If the patient poorly responds to conventional therapies,bronchoscopic extraction of casts should be carried out early. Meanwhile we should master the pointers and strategies of mechanical ventilation to reduce the oc-currence of the complications associated.

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白 科,林晓娟, 刘成军.小儿危重症甲型流感并发塑型支气管炎15例临床分析[J].重庆医科大学学报,2015,(1):140-143

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  • 在线发布日期: 2015-11-09
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