摘要
目的分析甲型H1N1流感引致塑型支气管炎（PB）的诊治特点。方法对2009年和2010年2年冬季深圳市儿童医院收治的8例甲型H1N1流感引起的PB患儿的临床表现、支气管镜检查及其吸出物的病理、治疗经过和转归进行回顾性分析。结果8例均为男性；年龄3岁3个月～6岁6个月；其中2009年冬季5例，占同期因H1N1流感住院患儿的3．3％（5／150）；2010年冬季3例，占同期因H1N1流感住院的15．8％（3／19）。2例伴有基础疾病，1例为支气管哮喘，1例为过敏性鼻炎和皮肤过敏。所有患儿均有发热，咳嗽和咯痰，喘息2例，呼吸困难5例。诊断均为重症甲型H1N1流感合并肺炎，其中伴肺不张5例，气胸2例，纵隔气肿1例，胸腔积液1例，2例可疑支气管异物。7例人住ICU，5例呼吸衰竭，3例需要接受气管插管和机械通气。所有患儿均使用可弯曲支气管镜检查，吸出树样支气管管型，病理检查7例为纤维素性渗出，伴有中性粒细胞、嗜酸粒细胞和淋巴细胞浸润；1例为纤维素性渗出伴坏死改变。所有患儿经过吸除树样支气管管型后，病情得到明显改善，无死亡病例。结论PB是一种潜在危及生命的甲型H1N1流感的合并症之一，临床上出现急性起病、进行性呼吸困难，伴有肺不张或实变时，应该想到本病，尽早进行支气管镜检查，以明确诊断和及时治疗。
Objective To analyze the clinical characteristics of plastic bronchitis associated with 2009 influenza A virus （H1N1） infection. Method A retrospective investigation of the clinical manifestation, bronchoscopy, and the histology of the cast, clinical course and outcome of 8 children with plastic bronchitis associated with influenza A virus （ H1 N1 ） infection during winter of 2009 and 2010 was performed. Result All 8 cases were boys, the range of age was 3 to 6 years. Five cases occurred in 2009 winter, accounting for 3.3% （5/150） of hospitalized children with influenza A （H1N1） infection; 3 cases occurred in 2010 winter, accounting for 15.8% （3/19） of hospitalized children with influenza A （H1N1） infection. Two patients had an underlying chronic disease, 1 had asthma, and the other had allergic rhinitis and atopic dermatitis. All the 8 cases had fever, cough and sputum; 2 had wheezing; 5 had respiratory distress. All 8 cases were diagnosed as influenza A virus （H1N1） infection complicated with pneumonia, of whom 5 patients had ateleetasis, 2 had pneumothorax, 1 had pneumomediastinum, 1 had parapneumonic effusion, 2 patients were suspected of foreign body aspiration. Seven cases were admitted to an ICU, 5 patients developed respiratory failure, and 3 patients required mechanical ventilation. Flexible bronchoscopy and bronchial lavage was performed in all cases and showed bronchial cast. Histological examination of the bronchial cast revealed a fibrinous material containing large quantity of eosinophils, neutrophils, and lymphocytes in 7 patients, fibrinous material and necrotic material without inflammatory cells in 1 patient. After the bronchial cast was removed, all patients were improved greatly, no patients died. Conclusion Plastic bronchitis is a life-threatening complication associated with 2009 influenza A （H1N1） virus infection in children. In children with rapid and progressive respiratory distress with lung atelectasis or consolidation on chest radiograph, plastic bronchi
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2012年第7期521-524,共4页
Chinese Journal of Pediatrics
