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目的分析儿童塑形性支气管炎的临床特征,总结治疗经验和教训。方法回顾性分析已确诊的14例儿童塑形性支气管炎患儿的临床资料。14例中2岁以下患儿12例。该病发病急骤,有8例病程仅半天。临床表现均以呼吸系统梗阻和严重缺氧为主,人工面罩给氧情况下血氧饱和度仍在0.70～0.80之间;中重度发热8例次,咳出胶冻状碎片样物4例次。X 线表现为一侧(10例)或双侧(2例)肺气肿或肺不张,一侧肺纹理增粗、见斑片状阴影(2例)。12例进行支气管镜探查和异物钳取术,2例行气管插管术。结果 14例患儿中12例行支气管镜手术,一次手术治愈8例,取出内生性支气管树样异物;4例患儿再次手术,其中3例又钳取条索状异物,治愈;1例麻醉诱导时肺大出血死亡。早期的2例患儿病情危重,行气管插管术后没有好转,终因多器官功能衰竭死亡。病理检杏取出的内生性异物,主要由含纤维素的黏液素组成,可见炎性细胞的Ⅰ型6例;无炎性细胞的Ⅱ型8例。结论儿童塑形性支气管炎是一种高危性疾病,其内生性异物局部或广泛性堵塞支气管,导致肺部分或全部通气功能障碍,确诊需依靠支气管镜探查和病理组织检查,支气管镜下异物钳取术是惟一有效的手段。
Objective To analyze the clinical characteristics of children with plastic bronchitis, summarize the experience and lessons learned. Methods Retrospective analysis of 14 cases of children diagnosed with plastic bronchitis clinical data. Among 14 cases, 12 cases were below 2 years old. The incidence of this disease is abrupt, there are 8 cases of course only half a day. Clinical manifestations were mainly respiratory obstruction and severe hypoxia, artificial oxygen mask mask oxygen saturation is still between 0.70 to 0.80; moderate to severe fever in 8 cases, cough out of jelly-like debris in 4 cases . X-ray showed one side (10 cases) or bilateral (2 cases) emphysema or atelectasis, one side of the lung texture thickening, see the patchy shadows (2 cases). 12 cases of bronchoscopy and foreign body forceps, 2 cases of endotracheal intubation. Results Twelve of 14 children underwent bronchoscopic surgery. Eight patients were cured by one operation, and endobronchial tree-like foreign bodies were removed. Four patients underwent reoperation, and three of them were clamped to remove cord-like foreign bodies and were cured. One patient was anesthetized Induction of pulmonary hemorrhage death. Early two cases of critically ill children, tracheal intubation did not improve after the operation, the end result of multiple organ failure. Pathological Pleurotus remove the endogenous foreign body, mainly composed of cellulose mucin, inflammatory cells can be seen in type Ⅰ 6 cases; type Ⅱ 8 cases of inflammatory cells. Conclusion Children’s plastic bronchitis is a high-risk disease, the endogenous or foreign body endocrinological blockage of the bronchi, leading to some or all of the pulmonary ventilation dysfunction, diagnosis depends on bronchoscopy and pathological examination, bronchoscopic foreign body forceps Take surgery is the only effective means.