麻疹并发闭塞性细支气管炎患儿六例临床分析
发布时间：2018-11-24 09:10
【摘要】：目的探讨麻疹并发闭塞性细支气管炎的临床特点。方法分析2012年3月—2014年3月河北省儿童医院确诊为麻疹并发闭塞性细支气管炎的6例患儿的临床资料,包括性别、月龄、临床特点、血气分析特点、肺功能检查、影像学检查、纤维支气管镜检查、诊疗经过及随访情况等。结果 6例患儿中男5例、女1例,发病月龄8~15个月。急性感染期病情严重,均表现为反复发热、呼吸困难明显;持续期以喘息、混合型呼吸困难为主要临床表现,以三凹征阳性、肺部闻及喘鸣音为主要体征。血气分析均提示低氧血症伴二氧化碳潴留,肺功能检查提示小气道阻塞性通气功能障碍4例,混合性通气功能障碍2例。肺CT表现为典型的"马赛克灌注征"4例,肺间质改变2例,支气管扩张1例,过度充气1例。治疗方面急性感染期均给予持续正压通气辅助呼吸、免疫球蛋白、甲泼尼龙、抗感染等对症治疗,持续期口服小剂量阿奇霉素、泼尼松片、孟鲁司特联合布地奈德雾化吸入等治疗。随访1.0~2.5年,6例患儿均未死亡,其中5例临床症状、血气分析、肺功能分别得到了一定程度的好转,1例生长发育迟缓、临床症状无明显改善。结论麻疹并发闭塞性细支气管炎的患儿发病年龄较小,临床表现以慢性咳嗽、喘息、反复呼吸道感染为主,肺CT以通气不均匀、"马赛克灌注征"为特点,血气分析多提示Ⅱ型呼吸衰竭,肺功能检查多见阻塞性通气功能障碍,治疗早期应用激素、免疫球蛋白对预后有一定程度改善作用。
[Abstract]:Objective to investigate the clinical features of measles complicated with bronchiolitis obliterans. Methods the clinical data of 6 children with measles complicated with bronchiolitis obliterans in Hebei Children's Hospital from March 2012 to March 2014 were analyzed, including sex, age, clinical characteristics, blood gas analysis and pulmonary function examination. Imaging examination, fiberoptic bronchoscopy, diagnosis and treatment and follow-up. Results among 6 cases, 5 cases were male and 1 case female, the age of onset was 8 ~ 15 months. The symptoms of acute infection were severe, with repeated fever, dyspnea, wheezing, mixed dyspnea as the main clinical manifestation, positive triple concave sign, lung smell and wheezing sound as the main signs. Blood gas analysis showed that hypoxemia with carbon dioxide retention, pulmonary function examination showed small airway obstructive ventilation dysfunction in 4 cases, mixed ventilation dysfunction in 2 cases. CT showed typical "mosaic perfusion sign" in 4 cases, pulmonary interstitial change in 2 cases, bronchiectasis in 1 case, hyperinflation in 1 case. In the treatment of acute infection, all patients were given continuous positive pressure ventilation to assist breathing, immunoglobulin, methylprednisolone, anti-infection and other symptomatic treatment, the duration of oral administration of azithromycin, prednisone tablets, Montelukast combined with budesonide atomization inhalation and other treatment. During the follow-up period of 1.0 ~ 2.5 years, no death was found in 6 cases. Among them, 5 cases had clinical symptoms, blood gas analysis and lung function were improved to some extent, and 1 case had growth retardation and no obvious improvement in clinical symptoms. Conclusion the children with measles complicated with bronchiolitis obliterans have a younger age, the clinical manifestations are chronic cough, wheezing, recurrent respiratory tract infection, and CT is characterized by uneven ventilation and "mosaic perfusion sign". Blood gas analysis showed that type 鈪，
本文编号：2353095
[Abstract]:Objective to investigate the clinical features of measles complicated with bronchiolitis obliterans. Methods the clinical data of 6 children with measles complicated with bronchiolitis obliterans in Hebei Children's Hospital from March 2012 to March 2014 were analyzed, including sex, age, clinical characteristics, blood gas analysis and pulmonary function examination. Imaging examination, fiberoptic bronchoscopy, diagnosis and treatment and follow-up. Results among 6 cases, 5 cases were male and 1 case female, the age of onset was 8 ~ 15 months. The symptoms of acute infection were severe, with repeated fever, dyspnea, wheezing, mixed dyspnea as the main clinical manifestation, positive triple concave sign, lung smell and wheezing sound as the main signs. Blood gas analysis showed that hypoxemia with carbon dioxide retention, pulmonary function examination showed small airway obstructive ventilation dysfunction in 4 cases, mixed ventilation dysfunction in 2 cases. CT showed typical "mosaic perfusion sign" in 4 cases, pulmonary interstitial change in 2 cases, bronchiectasis in 1 case, hyperinflation in 1 case. In the treatment of acute infection, all patients were given continuous positive pressure ventilation to assist breathing, immunoglobulin, methylprednisolone, anti-infection and other symptomatic treatment, the duration of oral administration of azithromycin, prednisone tablets, Montelukast combined with budesonide atomization inhalation and other treatment. During the follow-up period of 1.0 ~ 2.5 years, no death was found in 6 cases. Among them, 5 cases had clinical symptoms, blood gas analysis and lung function were improved to some extent, and 1 case had growth retardation and no obvious improvement in clinical symptoms. Conclusion the children with measles complicated with bronchiolitis obliterans have a younger age, the clinical manifestations are chronic cough, wheezing, recurrent respiratory tract infection, and CT is characterized by uneven ventilation and "mosaic perfusion sign". Blood gas analysis showed that type 鈪，
本文编号：2353095
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