儿童感染后支气管扩张症1例报道并文献复习

目的:探讨儿童支气管扩张症的临床特征及诊治要点.方法:回顾分析1例儿童支气管扩张症的临床表现、诊疗经过及预后,并结合文献分析.结果:患儿,男,8岁,以反复喘息、咳嗽为首发症状,后逐渐出现大量咳脓痰.既往有重症肺炎、肺炎支原体感染、乙型流感病史.肺部高分辨率CT(HRCT)早期无特异性,后期提示支气管扩张症;纤维支气管镜(纤支镜)提示化脓性支气管炎、支气管扩张症.排除其他病因后,确诊为感染后支气管扩张症.有效抗感染治疗后咳、痰、喘好转.经长期规律随访,坚持体位引流、呼吸训练、抗炎(糖皮质激素吸入、小剂量阿奇霉素口服)等治疗,急性发作次数逐渐减少,最终达到影像学上的治愈,肺功能正常,预后良好.结论:儿童支气管扩张症早期诊断困难,对于反复喘息、咳嗽患儿,应考虑支气管扩张症,动态监测肺部HRCT、肺功能、纤支镜等,并积极寻找潜在病因.儿童感染后支气管扩张症早诊断、早治疗,有可能完全康复.

A Case Report of Post-Infection Bronchiectasis in Children and Literature Review

Objective: To explore the clinical features, diagnosis and treatment of children with bronchiectasis. Methods: The clinical manifestation, diagnosis, treatment and prognosis of a case of bronchiectasis in children were retrospectively analyzed. Results: A boy aged 8 years was admitted due to recurrent wheezing and coughing as the first symptom, and then developed copious purulent sputum and chest tightness. The child had a history of severe pneumonia, Mycoplasma pneumoniae infection and influenza B. High resolution CT (HRCT) showed no specificity at early stage and suggested bronchiectasis at late stage. Fiberoptic bronchoscopy showed purulent bronchitis and bronchiectasis. After excluding other causes, the child was diagnosed as post-infection bronchiectasis. Cough, sputum and asthma were improved after effective anti-infection treatment. After long-term follow-up, autogenic drainage, active respiratory training and anti-inflammatory treatment (inhalation of glucocorticoid, oral administration of small doses of azithromycin) and other treatments, the number of acute attacks decreased, and eventually achieved the radiographic recovery, normal pulmonary function and favourable prognosis. Conclusion: Early diagnosis of bronchiectasis in children is difficult. For children with recurrent wheezing and cough, bronchiectasis should be considered, and HRCT, pulmonary function and fiberoptic bronchoscopy should be dynamically detected, potential causes should be actively sought. Early diagnosis and treatment of post-infection bronchiectasis in children may lead to complete recovery