63例儿童流行性感冒合并塑型性支气管炎的临床特征分析

Clinical features of children with influenza and plastic bronchitis: an analysis of 63 cases

摘要:

目的 研究儿童流行性感冒（简称流感）合并塑型性支气管炎的临床特征。方法 回顾性分析63例流感合并塑型性支气管炎患儿的临床表现、实验室检查、影像学、治疗及转归特点。结果 63例患儿中，男52例（83%），女11例（17%），其中甲型流感42例，乙型流感21例。3~6岁儿童38例（60％）。15例（24%）有基础性疾病。主要的临床表现包括高热（90%）、咳嗽（95%）和气促（73%）。影像学检查显示肺不张24例（38%）。16例（25%）听诊无肺部啰音。入住重症监护室41例，呼吸机辅助通气32例。63例患儿均行纤维支气管镜检查及肺泡灌洗。好转60例，死亡3例。结论 儿童流感合并塑型性支气管炎以男性及学龄前儿童多见。对于有气促的流感患儿，即使胸部X线未提示肺不张或听诊无肺部啰音，也需要警惕合并塑型性支气管炎的可能。

Abstract:

Objective To study the clinical features of children with influenza and plastic bronchitis (PB). Methods A retrospective analysis was performed on the medical data of 63 children with influenza and PB, including clinical manifestations, laboratory examination results, imaging findings, treatment, and outcome. Results Among the 63 children, there were 52 boys (83%) and 11 girls (17%), and 42 children had influenza A and 21 had influenza B. Among these children, 38 (60%) aged 3-6 years, and 15 (24%) had underlying diseases. The main clinical manifestations were high fever (90%), cough (95%), and shortness of breath (73%). Twenty-four children (38%) were found to have atelectasis by imaging examination. Auscultation showed that 16 children (25%) had no rales in the lungs. Of all children, 41 were admitted to the intensive care unit, and 32 required mechanical ventilation. All children underwent fiberoptic bronchoscopy and alveolar lavage. Among the 63 children, 60 recovered and 3 died. Conclusions Influenza with PB is often observed in boys and preschool children. For influenza children with shortness of breath, even if there is no atelectasis on chest X-ray or no rales are found by auscultation, the possibility of PB still needs to be considered.