摘要
目的 探讨儿童迁延性细菌性支气管炎（PBB）的临床特点和治疗。方法 回顾性分析2013年5月—2015年4月经支气管镜检查确诊的PBB患儿临床资料。结果 共纳入31例PBB患儿,男18例、女13例,其中年龄〈6岁28例;均为湿性咳嗽,在夜间、晨起及活动后明显;伴有喘息17例、肺部痰鸣音16例;病程中位时长2个月;外周血白细胞正常18例、稍高13例;C-反应蛋白正常28例;查胸部X线平片,正常或肺纹理增多16例;24例查肺部CT示气管或支气管狭窄改变5例。31例均行气管镜检查,可见气管内膜分泌物附着,4例气管软化,无气道狭窄。支气管肺泡灌洗液（BALF）检测示中性粒细胞比例中位数80%;细菌培养阳性17例,其中肺炎链球菌6例、副流感嗜血杆菌6例、卡他莫拉菌3例、金黄色葡萄球菌2例、流感嗜血杆菌1例,其中1例为混合感染。抗生素治疗2~4周23例,〉4周8例。23例痊愈,其中停药后复发8例;另8例抗生素治疗不能彻底痊愈,其中7例后续治疗鼻窦炎、过敏性鼻炎等合并症后痊愈,1例原因不明。结论 儿童PBB多见于6岁以下,表现为慢性湿咳,可伴喘息、痰鸣音,需气管镜检查确诊。抗生素治疗有效,病程2~4周以上,但易复发;抗生素治疗无效时,注意合并症。
Objective To study the diagnosis and treatment of protracted bacterial bronchitis （PBB） in children. Methods Children with PBB confirmed by bronchoscopy were recruited from May 2013 to April 2015 . The clinical data were retrospectively analyzed. Results All 31 cases include 18 boys and 13 girls were recruited. 28 / 31 were younger than 6 years old. They all complained of wet cough, some of them were reported with wheeze （ 17 / 31 ） and with ruttle in the lungs （ 16 / 31 ）. White blood cell were in normal range （ 18 / 31 ） or slightly elevated （ 13 / 31 ）. The C-reactin protein was in normal range （ 28 / 31 ）. Chest X-ray test of 16 cases were normal. Twenty-four cases taken chest computerized tomograph scan, 5 had a sign of tracheobronchial stenosis. The purulent bronchitis without tracheobronchial stenosis were confirmed by bronchoscopy. Four cases had tracheomalacia. The medians of proportion of neutrophil were 80 % in bronchoalveolar lavage fluid （BALF）. The pathogens were identified in BALF in 17 cases, 6 with Streptococcus pneumoniae, 6 with Haemophilus parainfluenzae, 3 with Moraxella catarrhalis, 2 with Staphylococcus aureus and 1 with Haemophilus influenzae. The symptoms were improved in all cases and co-amoxiclav was prescribed to most cases when discharged. The course of antibiotics therapy was 2 - 4 weeks in 23 cases, and more than 4 weeks in 8 cases. Twenty-three （ 23 ） cases were cured but 8 of them relapsed. Another 8 cases were improved but not completely remitted, 7 / 8 were cured by further treatment for concomitant diseases such as nasosinusitis and allergic rhinitis. Conclusions Children with PBB are typically younger than six years old, and presented with prolonged wet cough and parent-reported wheeze, normal or with ruttle in the lungs. A confirmed diagnosis was reached by bronchoscopy. The antibiotics therapy were effective, the course should be more than 2-4 weeks, however, relapse were common. When antibiotics therapy does not lead to complete remission, concomitant diseases should be considered.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2016年第8期575-579,共5页
Journal of Clinical Pediatrics
关键词
迁延性细菌性支气管炎
迁延性支气管炎
化脓性支气管炎
支气管镜检查
儿童
protracted bacterial bronchitis/persistent bacterial bronchitis
protracted bronchitis
purulent bronchitis
bronchoscopy
child
