儿童间质性肺疾病的临床研究

发布时间：2018-05-05 09:08

本文选题：间质性肺疾病 + 临床表现　；参考：《大连医科大学》2013年硕士论文

【摘要】：目的分析儿童间质性肺疾病的临床表现、胸部CT征象、肺功能变化及支气管镜镜下特点，为儿童间质性肺疾病的诊断和治疗提供临床思路。方法采用回顾性分析的方法，选择2011年1月至2012年6月在大连市儿童医院呼吸病房住院，符合纳入标准、临床诊断间质性肺疾病的患者49例，总结分析其临床表现、胸部CT征象、肺功能变化及支气管镜镜下特点，并将各项结果记录至病例登记表。结果 1.在49例儿童间质性肺疾病患者中，男性患者占75.5%；2岁的患者占61.2%；病因不明者占57.2%，和感染相关者占36.7%，和奶汁吸入相关者占6.1%。 2.在49例儿童间质性肺疾病患者中，45例患者进行了血清病毒抗体测定，病毒抗体的阳性率为17.8%；其中呼吸道合胞病毒感染者2例，腺病毒感染者5例，副流感病毒感染者1例。41例患者进行了肺炎支原体抗体测定，肺炎支原体抗体的阳性率为4.9%。22例患者进行了支气管肺泡灌洗液细菌培养，灌洗液细菌培养的阳性率为36.4%，其中肺炎链球菌感染者1例，流感嗜血杆菌感染者3例，大肠埃希菌感染者2例，鲍氏不动杆菌感染者2例。所有病原学检测阳性的患者均为单一病原体感染。 3.在49例儿童间质性肺疾病患者中，，临床表现为咳嗽者占98.0%；活动后呼吸困难者占93.9%；低至中等程度发热者占51.0%。肺部听诊闻及湿Up音者占57.1%；肺部听诊闻及喘鸣音者占53.1%；肺部听诊未见异常者占28.6%。 4.49例儿童间质性肺疾病患者均进行了胸部CT检查，胸部CT出现磨玻璃影者占93.9%；出现网状阴影者占46.9%；伴肺不张者占2.0%；伴胸膜增厚者占2.0%；伴实变影者占36.7%；伴气肿者占8.2%。 5.在49例儿童间质性肺疾病患者中，32例患者进行了肺功能检查，均表现不同程度的肺通气功能障碍；其中阻塞性通气功能障碍者占93.8%；混合性通气功能障碍者占6.2%。 6.在49例儿童间质性肺疾病患者中，22例患者进行了支气管镜检查，支气管镜镜下表现粘膜轻-中度充血、肿胀，管嵴轻-中度增宽，管口轻-中度减小的患者占100%；支气管镜镜下见黄白色粘稠分泌物、痰块样分泌物、坏死物者占86.4%，奶汁样分泌物者占13.6%。结论 1.儿童间质性肺疾病以男性患者为主，2岁以内好发，57.2%的患者病因不明，36.7%的患者病因和感染相关，6.1%的患者病因和奶汁吸入相关。 2.儿童间质性肺疾病中90%以上的患者出现咳嗽、活动后呼吸困难；50%以上的患者肺部听诊可闻及湿Up音、喘鸣音。 3.儿童间质性肺疾病中90%以上的患者胸部CT呈磨玻璃影，近1/2的患者呈网状阴影；约1/3的患者伴实变影。 4.儿童间质性肺疾病中90%以上的患者肺功能表现为阻塞性通气功能障碍。 5.儿童间质性肺疾病中100%的患者支气管镜镜下表现粘膜轻-中度充血、肿胀，管嵴轻-中度增宽，管口轻-中度减小；86.4%的患者镜下可见黄白色粘稠分泌物、痰块样分泌物、坏死物；13.6%的患者镜下可见奶汁样分泌物。
[Abstract]:Objective to analyze the clinical manifestations of interstitial lung disease in children, the CT signs of the chest, the changes of lung function and the characteristics of bronchoscopy, so as to provide clinical ideas for the diagnosis and treatment of interstitial lung disease in children.
Methods a retrospective analysis was used to select 49 patients who were hospitalized in the respiratory ward of Dalian children's Hospital from January 2011 to June 2012. The clinical manifestations, chest CT signs, pulmonary function changes and bronchoscopy characteristics were summarized and analyzed, and the results were recorded to the cases. Take a note.
Result
1. among 49 children with interstitial lung disease, 75.5% were male, 61.2% were 2 years of age, 57.2% were unknown, 36.7% were associated with infection, and 6.1%. associated with milk inhalation accounted for the proportion of patients.
2. in 49 cases of children with interstitial lung disease, 45 patients had serum antibody test, the positive rate of virus antibody was 17.8%, of which 2 cases of respiratory syncytial virus infection, 5 cases of adenovirus infection, 1 cases of parainfluenza virus infection in.41 patients were tested for the antibody of Mycoplasma pneumoniae and the positive rate of Mycoplasma pneumoniae antibody. The bacterial culture of bronchoalveolar lavage fluid was carried out for 4.9%.22 patients. The positive rate of bacterial culture in the lavage liquid was 36.4%, of which 1 cases were Streptococcus pneumoniae, 3 cases of Haemophilus influenzae, 2 cases of Escherichia coli infection and 2 cases of Acinetobacter baumannii infection. All the patients with positive detection were single pathogen infection.
3. among 49 children with interstitial lung disease, 98% were coughs, 93.9% were dyspnea after activity, 57.1% of 51.0%. pulmonary auscultation and wet Up sound, 53.1% of pulmonary auscultation and wheezing, and no 28.6%. in pulmonary auscultation.
4.49 cases of children with interstitial lung disease were examined by chest CT, 93.9% with glass shadow in chest, 46.9% with reticular shadow, 2% with non open lung, 2% with pleural thickening, 36.7% with pleural thickening, 36.7% with real change, and 8.2%. with emphysema.
5. in 49 cases of children with interstitial lung disease, 32 patients had pulmonary function examination, which showed different degrees of pulmonary ventilation dysfunction, of which 93.8% were obstructive ventilatory dysfunction, and mixed ventilation dysfunction accounted for 6.2%..
6. in 49 cases of children with interstitial lung disease, 22 patients underwent bronchoscopy. Bronchoscopy showed mild to moderate hyperemia, swelling, light and medium width of tubular ridge, 100% of light to moderate decrease in the mouth, and bronchoscopy with yellow white sticky secretions, sputum like secretions, 86.4% necrosis, milk sample. 13.6%.
conclusion
1. children with interstitial lung disease were mainly male patients, 2 years old, 57.2% of the patients were unknown, 36.7% of the patients were associated with the cause of infection, and 6.1% of the patients were associated with milk inhalation.
2. in children with interstitial lung disease, more than 90% of the patients developed cough, breathing difficulties after exercise, and 50% of the patients had lung auscultation audible and wet Up sounds and wheezing sounds.
3. of the children with interstitial lung disease, more than 90% of the patients had CT in the chest, and nearly 1/2 showed a mesh shadow. About 1/3 of the patients had consolidation.
4. of the children with interstitial lung disease, more than 90% of the patients had obstructive pulmonary dysfunction.
Of 5. children with interstitial lung disease, 100% of the patients showed mild to moderate hyperemia, swelling, light and medium width of tubular ridge, light to moderate decrease in the canal, and 86.4% of the patients were visible with yellow and white mucous secretions, sputum like secretions, and bad dead objects, and 13.6% of the patients showed milk secretion.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.6

【参考文献】