CAJ | 학술논문

目的分析甲型H1N1流感引致塑型支气管炎(PB)的诊治特点.方法对2009年和2010年2年冬季深圳市儿童医院收治的8例甲型H1N1流感引起的PB患儿的临床表现、支气管镜检查及其吸出物的病理、治疗经过和转归进行回顾性分析.结果 8例均为男性；年龄3岁3个月～6岁6个月；其中2009年冬季5例,占同期因H1N1流感住院患儿的3.3％(5/150)；2010年冬季3例,占同期因H1N1流感住院的15.8％ (3/19).2例伴有基础疾病,1例为支气管哮喘,1例为过敏性鼻炎和皮肤过敏.所有患儿均有发热,咳嗽和咯痰,喘息2例,呼吸困难5例.诊断均为重症甲型H1N1流感合并肺炎,其中伴肺不张5例,气胸2例,纵隔气肿1例,胸腔积液1例,2例可疑支气管异物.7例入住ICU,5例呼吸衰竭,3例需要接受气管插管和机械通气.所有患儿均使用可弯曲支气管镜检查,吸出树样支气管管型,病理检查7例为纤维素性渗出,伴有中性粒细胞、嗜酸粒细胞和淋巴细胞浸润；1例为纤维素性渗出伴坏死改变.所有患儿经过吸除树样支气管管型后,病情得到明显改善,无死亡病例.结论 PB是一种潜在危及生命的甲型H1N1流感的合并症之一,临床上出现急性起病、进行性呼吸困难,伴有肺不张或实变时,应该想到本病,尽早进行支气管镜检查,以明确诊断和及时治疗.
목적 분석갑형H1N1류감인치소형지기관염(PB)적진치특점.방법 대2009년화2010년2년동계심수시인동의원수치적8례갑형H1N1류감인기적PB환인적림상표현、지기관경검사급기흡출물적병리、치료경과화전귀진행회고성분석.결과 8례균위남성；년령3세3개월～6세6개월；기중2009년동계5례,점동기인H1N1류감주원환인적3.3％(5/150)；2010년동계3례,점동기인H1N1류감주원적15.8％ (3/19).2례반유기출질병,1례위지기관효천,1례위과민성비염화피부과민.소유환인균유발열,해수화각담,천식2례,호흡곤난5례.진단균위중증갑형H1N1류감합병폐염,기중반폐불장5례,기흉2례,종격기종1례,흉강적액1례,2례가의지기관이물.7례입주ICU,5례호흡쇠갈,3례수요접수기관삽관화궤계통기.소유환인균사용가만곡지기관경검사,흡출수양지기관관형,병리검사7례위섬유소성삼출,반유중성립세포、기산립세포화림파세포침윤；1례위섬유소성삼출반배사개변.소유환인경과흡제수양지기관관형후,병정득도명현개선,무사망병례.결론 PB시일충잠재위급생명적갑형H1N1류감적합병증지일,림상상출현급성기병、진행성호흡곤난,반유폐불장혹실변시,응해상도본병,진조진행지기관경검사,이명학진단화급시치료.
Objective To analyze the clinical characteristics of plastic bronchitis associated with 2009 influenza A virus (H1N1) infection. Method A retrospective investigation of the clinical manifestation,bronchoscopy,and the histology of the cast,clinical course and outcome of 8 children with plastic bronchitis associated with influenza A virus ( H1N1 ) infection during winter of 2009 and 2010 was performed.Result All 8 cases were boys,the range of age was 3 to 6 years.Five cases occurred in 2009 winter,accounting for 3.3％ (5/150) of hospitalized children with influenza A ( H1N1 ) infection; 3 cases occurred in 2010 winter,accounting for 15.8％ (3/19) of hospitalized children with influenza A ( H1N1 ) infection.Two patients had an underlying chronic disease,1 had asthma,and the other had allergic rhinitis and atopic dermatitis.All the 8 cases had fever,cough and sputum; 2 had wheezing; 5 had respiratory distress.All 8 cases were diagnosed as influenza A virus ( H1N1 ) infection complicated with pneumonia,of whom 5 patients had atelectasis,2 had pneumothorax,1 had pneumomediastinum,1 had parapneumonic effusion,2 patients were suspected of foreign body aspiration.Seven cases were admitted to an ICU,5 patients developed respiratory failure,and 3 patients required mechanical ventilation.Flexible bronchoscopy and bronchial lavage was performed in all cases and showed bronchial cast.Histological examination of the bronchial cast revealed a fibrinous material containing large quantity of eosinophils,neutrophils,and lymphocytes in 7 patients,fibrinous material and necrotic material witbout inflammatory cells in 1 patient.After the bronchial cast was removed,all patients were improved greatly,no patients died.Conclusion Plastic bronchitis is a life-threatening complication associated with 2009 influenza A (H1N1 ) virus infection in children.In children with rapid and progressive respiratory distress with lung atelectasis or consolidation on chest radiograph,plastic bronchitis should be considered.Bronchoscopic extraction of casts should be carried out early.