102例小儿咯血病因及临床诊治分析

目的：分析小儿咯血的病因、临床特点、治疗及预后，为儿科医生的诊断治疗提供参考。方法收集2009年4月至2014年12月重庆医科大学附属儿童医院以咯血为主诉住院患儿的临床表现、实验室检查、影像学、纤维支气管镜下表现、治疗方法及转归进行回顾性分析。结果102例咯血患儿中，男55例，女47例，年龄（7.05±1.02）岁，少量咯血87例（85.3％），中量咯血10例（9.8％），大量咯血5例（4.9％）。102例患儿中88例找到了比较确切的病因，其中以下呼吸道感染最为常见，前3位病因分别是：肺炎、肺结核和支气管炎，非感染性病因中以特发性肺含铁血黄素沉着症（IP H ）最常见，少见的还有结缔组织疾病、肺血管畸形、气道异物等，85例患儿胸部C T提示有不同程度的病变。35例完成纤维支气管镜检查，3例因肉芽增生导致气道狭窄的患儿予以冷冻治疗后缓解，5例镜下见活动性出血，予以局部止血治疗后出血停止，10例疑诊肺结核而痰菌阴性患儿中有8例经纤维支气管镜灌洗找到抗酸杆菌。小儿咯血治疗以内科对因及对症为主，多数患儿咯血呈自限性或经治疗后咯血很快停止。结论胸部CT可为咯血病因诊断提供重要依据，纤维支气管镜检查对咯血诊断及治疗均有重要价值。小儿咯血治疗以对因及对症为主，多数预后良好。

Analysis on etiology,clinical diagnosis and treatment of 102 pediatric hemoptysis cases

Objective To investigate the etiology,clinical charactieristics,treatment and prognosis in pediatric hemoptysis to provide reference for its diagnosis and treatment to pediatric doctors .Methods The retrospective analysis was performed on the clinical manifestations ,laboratory tests ,imagiological and bronchoscopic manifestations ,treatment methods and outcomes in the children patients with hemoptysis as the chief complaint admitted to our hospital from April 2009 and December 2014 .Results A-mong 102 children cases of hemoptysis ,55 cases were male and 47 cases were female .The median age was (7 .05 ± 1 .2) years old . Mild hemoptysis was in 87 cases(85 .3% ) ,moderate hemoptysis was in 10 cases(9 .8% ) and massive hemoptysis was in 5 cases (4 .9% ) .The relatively exact causes of hemoptysis were found in 88 cases ,in which the lower respiratory tract infection was most common ,the top 3 causes were pneumonia ,pulmonary tuberculosis and bronchitis .In the non-infection causes ,idiopathic pulmonary hemosiderosis(IPH) was most common ,while connective tissue diseases ,pulmonary vascular malformation and airway foreign body were rare .85 cases showed different pathological lesions on chest CT scan .Among the 35 cases underwent the bronchoscopy ,3 ca-ses of bronchial stenosis caused by granulation proliferation was improved after bronchoscopic cryotherapy ,5 cases of active bleed-ing under endoscopic stopped bleeding by topical hemostasis ,among 10 cases of suspected tuberculosis with negative sputum bacte-ria ,acid-fast bacilli was found in 8 cases by bronchofiberscopic lavage .The treatment of pediatric hemoptysis was dominated by the medical etiological and symptomatic therapy .Conclusion Chest CT scan can provide a very important basis for the etiological diag-nosis of hemoptysis and the bronchoscopy examination also has an important value in the diagnosis and treatment of hemoptysis . The etiological and symptomatic treatment is predominat in pediatric hemoptysis ,and the majority have good prognosis .