李洪燕 林业辉 陈进喜 张洁妍 张玉慧

摘要：目的  探討塑型性支气管炎（PB）的临床特点，提高临床医生对儿童PB的认识。方法  选择佛山市妇幼保健院2014年5月～2019年8月收治的39例PB患儿作为研究对象，分析其临床表现、实验室、影像学和支气管镜检查以及治疗经过、转归等。结果  患儿均有发热和咳嗽，34例（87.18%）为高热（体温峰值≥39.1℃），29例（74.36%）发热天数≥1周。33例（84.62%）患儿外周血C反应蛋白（CRP）升高，26例（66.67%）降钙素原（PCT）升高，16例（41.03%）血沉（ESR）增快。37例患儿肺CT表现以大片实变为主，2例以肺不张为主，18例合并胸腔积液，另外2例肺不张为主的患儿支气管镜显示存在异物。6例行3次支气管镜检查中， 2例（33.33%）应用机械通气治疗。全部病例均以好转或治愈出院，平均住院12.8 d。结论  塑型性支气管炎患儿临床表现为高热、咳嗽、呼吸增快，肺部影像学出现肺大片实变、肺不张、胸腔积液，血液检查提示CRP、PCT、ESR升高，常规抗感染治疗效果欠佳，另外，支气管异物亦可导致PB，建议及时行支气管镜检查明确病因。

关键词：塑型性支气管炎;儿童;纤维支气管镜

中图分类号：R725.6                               文献标识码：A                                   DOI：10.3969/j.issn.1006-1959.2020.15.024

文章编号：1006-1959（2020）15-0076-04

Abstract：Objective  To explore the clinical characteristics of plastic bronchitis （PB） and to improve clinicians' understanding of children with PB. Methods  A total of 39 children with PB admitted to Foshan Maternity and Child Health Hospital from May 2014 to August 2019 were selected as the research subjects to analyze their clinical manifestations， laboratory， imaging， bronchoscopy， treatment history， and outcome. Results  All children had fever and cough. 34 cases （87.18%） had high fever （peak temperature ≥39.1℃）， and 29 cases （74.36%） had fever ≥1 week. 33 children （84.62%） had increased peripheral blood C-reactive protein （CRP）， 26 （66.67%） had increased procalcitonin （PCT）， and 16 （41.03%） had increased erythrocyte sedimentation rate （ESR）. 37 patients with lung CT showed large-scale consolidation， 2 patients with atelectasis， 18 patients with pleural effusion， and the other 2 patients with atelectasis showed the presence of foreign bodies on bronchoscopy. Among 6 cases underwent 3 bronchoscopy， 2 cases （33.33%） were treated with mechanical ventilation. All cases were discharged from the hospital with improvement or cure， with an average hospital stay of 12.8 d.Conclusion  The clinical manifestations of children with plastic bronchitis are high fever， cough， and rapid breathing. Large-scale lung consolidation， atelectasis， and pleural effusion appear in lung imaging. Blood tests indicate elevated CRP， PCT， and ESR. Infection treatment is not effective. In addition， bronchial foreign bodies can also cause PB. It is recommended to perform bronchoscopy in time to determine the cause.

3讨论

PB是一种比较罕见、临床症状各异且可能存在致命风险的肺部疾病，其特征为内生性异物局部或广泛性堵塞支气管，导致肺部分或全部通气功能障碍。该病起病较隐匿，其诊断主要依靠支气管镜和病理组织学检查[2]。本组39例PB患儿中，男26例，女13例，男女比为2：1，男性患儿高于女性患儿，与国内文献报道一致，不同文献报道的男女之比各不相同[2，3]，男性患儿是否为PB高发因素，目前尚无大样本临床相关报道。……