69例小儿气管支气管软化症临床分析

发布时间：2018-03-29 12:04

本文选题：气管支气管软化　切入点：支气管镜　出处：《吉林大学》2014年硕士论文

【摘要】：目的：探讨小儿气管支气管软化症（TBM）的发病情况、支气管镜下病变特征、临床特点、并分析支气管镜术在其诊治中的价值，为TBM的临床诊断和治疗提供依据。方法：选取2009年1月至2013年10月，吉林大学第一医院小儿呼吸科年龄＜5岁、常规诊治无明显好转的反复或持续性喘息、反复肺炎、慢性咳嗽等患儿共201例，所有患儿均符合支气管镜检查适应症，对其行支气管镜检查，确诊TBM69例。对69例TBM患儿临床资料进行回顾性分析，包括一般情况、镜下病变特征、临床症状、体征、辅助检查、治疗、转归。结果： 1.性别构成：男52例，女17例，男女比例约为3:1；男孩TBM检出率高于女孩，性别差异有统计学意义（P＜0.05）。 2.年龄构成：年龄最小为6天，最大4岁；＜1岁40例，1~3岁27例，＞3岁2例；＜1岁TBM检出率明显高于其它年龄组，差异有统计学意义(P＜0.01）。 3.软化部位：气管软化12例，气管-支气管软化17例，支气管软化40例；右肺支气管软化多于左肺。软化程度以轻中度软化为主(90%)。 4.33例合并其它气道发育异常,4例合并先天性心脏病,2例合并食管闭锁。 5.69例TBM患儿中，反复或持续性喘息32例，慢性咳嗽18例，反复肺炎6例，肺不张8例，呼吸困难2例，长期痰鸣2例，呼吸机辅助通气撤机困难1例。 6.69例TBM全部由支气管镜明确诊断，胸部X线平片及胸部CT平扫、气道三维重建均未提示TBM。 7.镜检术中，根据镜下炎症情况对局部病变进行灌洗。经治疗66例症状明显缓解出院，1例气管切开带管出院，2例死亡。结论： 1.本组资料显示TBM多见于男孩及小于1岁患儿。 2. TBM临床表现多样，多为反复或持续性喘息、咳嗽，，容易误诊、漏诊。 3.支气管镜对小儿TBM诊断有确诊价值。
[Abstract]:Objective:. To investigate the incidence of tracheobronchomalacia in children, the pathological features and clinical features under bronchoscopy, and to analyze the value of bronchoscopy in the diagnosis and treatment of TBM, and to provide the basis for the clinical diagnosis and treatment of TBM. Methods:. From January 2009 to October 2013, 201 children with recurrent or persistent wheezing, recurrent pneumonia, chronic cough, and so on, were selected from the Department of Pediatric ventilation in the first Hospital of Jilin University, whose age was less than 5 years old. All the children were in accordance with the indications of bronchoscopy. The clinical data of 69 patients with TBM were analyzed retrospectively, including general condition, pathological features, clinical symptoms, signs and auxiliary examinations. Treatment, return. Results:. 1. Sex composition: 52 males and 17 females, the ratio of male to female was about 3: 1.The detection rate of TBM in boys was higher than that in girls (P < 0.05). 2. Age composition: the minimum age was 6 days, the maximum was 4 years old, the age < 1 year old was 40 cases, the age was 3 years old in 27 cases, > 3 years old in 2 cases, the detection rate of < 1 year old TBM was significantly higher than that of other age groups, the difference was statistically significant (P < 0.01). 3. There were 12 cases of tracheomalacia, 17 cases of tracheobronchomalacia, 40 cases of bronchiomalacia, and 40 cases of bronchomalacia in right lung. 4.33 cases with other airway dysplasia 4 cases with congenital heart disease 2 cases with esophageal atresia. There were 32 cases of recurrent or persistent wheezing, 18 cases of chronic cough, 6 cases of recurrent pneumonia, 8 cases of atelectasis, 2 cases of dyspnea, 2 cases of chronic phlegm and 1 case of ventilator assisted ventilation. 6. 69 cases of TBM were clearly diagnosed by bronchoscopy, chest X-ray plain film and chest CT plain scan, three dimensional reconstruction of the airway did not reveal TBM. 7.Intraoperative lavage of local lesions was carried out according to the inflammatory conditions under microscope. One case with tracheotomy and tube discharged from hospital died after 66 cases of symptoms were obviously relieved and discharged from hospital. Conclusion:. 1. The data showed that TBM was more common in boys and children under 1 years old. 2. The clinical manifestations of TBM were varied, including recurrent or persistent wheezing, cough, misdiagnosis and missed diagnosis. 3. Bronchoscopy is valuable for the diagnosis of TBM in children.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

【参考文献】