临床儿科杂志 ›› 2016, Vol. 34 ›› Issue (8): 575-.doi: 10.3969/j.issn.1000-3606.2016.08.004

• 呼吸系统疾病专栏 • 上一篇    下一篇

儿童迁延性细菌性支气管炎临床特点和治疗

陈杰华, 李志川, 马红玲, 王文建, 徐建强, 郑跃杰   

  1. 深圳市儿童医院呼吸科(广东深圳 518026)
  • 收稿日期:2016-08-15 出版日期:2016-08-15 发布日期:2016-08-15
  • 通讯作者: 郑跃杰 E-mail:yuejiez@sina.com

Clinical features and treatment of protracted bacterial bronchitis in children

CHEN Jiehua, LI Zhichuan, MA Hongling, WANG Wenjian, XU Jianqiang, ZHENG Yuejie   

  1. Department of Respiratory, Shenzhen Children’s Hospital, Shenzhen 518026 , Guangdong, China
  • Received:2016-08-15 Online:2016-08-15 Published:2016-08-15

摘要: 目的 探讨儿童迁延性细菌性支气管炎(PBB)的临床特点和治疗。方法 回顾性分析2013 年5 月—2015 年4 月经支气管镜检查确诊的PBB患儿临床资料。结果 共纳入31 例PBB患儿,男18 例、女13 例,其中年龄<6岁28 例;均为湿性咳嗽,在夜间、晨起及活动后明显;伴有喘息17例、肺部痰鸣音16例;病程中位时长2个月;外周血白细胞正常18例、稍高13 例; C- 反应蛋白正常28 例;查胸部X线平片,正常或肺纹理增多16 例;24 例查肺部CT示气管或支气管狭窄改变5 例。31 例均行气管镜检查,可见气管内膜分泌物附着,4 例气管软化,无气道狭窄。支气管肺泡灌洗液(BALF)检测示中性粒细胞比例中位数80%;细菌培养阳性17 例,其中肺炎链球菌 6 例、副流感嗜血杆菌6 例、卡他莫拉菌3 例、金黄色葡萄球菌2 例、流感嗜血杆菌1 例,其中1 例为混合感染。抗生素治疗2 ~ 4 周23 例,>4周8 例。23 例痊愈,其中停药后复发8 例;另8 例抗生素治疗不能彻底痊愈,其中7 例后续治疗鼻窦炎、过敏性鼻炎等合并症后痊愈,1 例原因不明。结论 儿童PBB多见于6 岁以下,表现为慢性湿咳,可伴喘息、痰鸣音,需气管镜检查确诊。抗生素治疗有效,病程2 ~ 4 周以上,但易复发;抗生素治疗无效时,注意合并症。

Abstract: Objective To study the diagnosis and treatment of protracted bacterial bronchitis (PBB) in children. Methods Children with PBB confirmed by bronchoscopy were recruited from May 2013 to April 2015 . The clinical data were retrospectively analyzed. Results All 31 cases include 18 boys and 13 girls were recruited. 28 / 31 were younger than 6 years old. They all complained of wet cough, some of them were reported with wheeze ( 17 / 31 ) and with ruttle in the lungs ( 16 / 31 ). White blood cell were in normal range ( 18 / 31 ) or slightly elevated ( 13 / 31 ). The C-reactin protein was in normal range ( 28 / 31 ). Chest X-ray test of 16 cases were normal. Twenty-four cases taken chest computerized tomograph scan, 5 had a sign of tracheobronchial stenosis. The purulent bronchitis without tracheobronchial stenosis were confirmed by bronchoscopy. Four cases had tracheomalacia. The medians of proportion of neutrophil were 80 % in bronchoalveolar lavage fluid (BALF). The pathogens were identified in BALF in 17 cases, 6 with Streptococcus pneumoniae, 6 with Haemophilus parainfluenzae, 3 with Moraxella catarrhalis, 2 with Staphylococcus aureus and 1 with Haemophilus influenzae. The symptoms were improved in all cases and co-amoxiclav was prescribed to most cases when discharged. The course of antibiotics therapy was 2 - 4 weeks in 23 cases, and more than 4 weeks in 8 cases. Twenty-three ( 23 ) cases were cured but 8 of them relapsed. Another 8 cases were improved but not completely remitted, 7 / 8 were cured by further treatment for concomitant diseases such as nasosinusitis and allergic rhinitis. Conclusions Children with PBB are typically younger than six years old, and presented with prolonged wet cough and parent-reported wheeze, normal or with ruttle in the lungs. A confirmed diagnosis was reached by bronchoscopy. The antibiotics therapy were effective, the course should be more than 2-4 weeks, however, relapse were common. When antibiotics therapy does not lead to complete remission, concomitant diseases should be considered.