闭塞性细支气管炎5例临床分析

目的 了解闭塞性细支气管炎(BO)的临床特征,总结BO的诊治经验.方法 对2008年6月至2010年12月临床诊断BO的5例患儿临床特点、影像学、治疗及转归进行总结并结合文献进行分析.结果 5例患儿中,2例为Steven-Johnson综合征(SJS)后,另3例为重症肺炎后.3例重症肺炎后BO患儿中,1例痰分离出腺病毒,1例3次痰培养均为肺炎克雷伯杆菌,而2例患儿的肺泡盥洗液培养均阴性;另1例多次痰培养均为鲍曼不动杆菌,其肺泡盥洗液培养为产ESBL-大肠埃希菌.5例患儿均有持续咳嗽、喘息症状,均有三凹症.3例重症肺炎后BO患儿的病程中均有心力衰竭,其中2例有呼吸衰竭,需机械通气.5例患儿起病后均有反复下呼吸道感染.5例肺CT均提示小气道病变,其中2例重症肺炎后BO患儿同时伴支气管扩张,1例还伴肺不张.4例BO患儿行纤维支气管镜检查,均提示支气管内膜炎症.5例BO患儿均使用泼尼松、阿奇霉素口服治疗,治疗过程中仍有症状持续,无死亡病例.结论 BO患儿临床以持续咳嗽、喘息为特点,肺CT以小气道病变为特点,易发生反复下呼吸道感染.目前治疗以激素为主,疗效不确定.

Clinical feature of five cases with bronchiliotis obliterans

Objective To recognize the clinical features of the bronchiolitis obliterans(BO)and summary the experiences of the diagnosis and treatment of BO.Methods Clinical manifestation,chest X-ray,computed tomography(CT)of 5 patients with BO from August 2008 to December 2010 were reviewed and analyzed retrospectively.Results Two cases were after Stevens-Johnson syndrome(SJS);the other 3 were after severe pneumonia,including one was found positive adenovirus in sputum culture,Klebsiella pneumonia and Acinetobacter baumannii were found in other 2 cases,respectively.Among these 3 cases,bronchoalveolar lavage fluid culture was found negative in the first 2 cases and ESBL-colon bacillus was found in the third case.All 5 cases suffered from persistent cough,wheezing and three depressions sign.In the course of 3 BO after severe pneumonia,they all suffered heart failure,2 of them suffered respiratory failure and used mechanical ventilation.All 5 cases suffered repeat lower respiratory infection and small airway lesion presented by pulmonary CT.Bronchiectasis was seen in 2 after severe pneumonia cases and one of them was with atelectasis.Flexible bronchofiberscope examination was operated in 4 cases,only endotracheitis was found.Prednisone and Azithromycin were given orally in all the cases,but the clinical symptoms were persistent in the course of treatment though there was no death occurs.Conclusions Clinical symptoms of BO are cough and wheezing.Small airway lesions present in pulmonary CT.Repeated lower respiratory infection is common in the BO.Prednisone is widely used in treatment of BO,but the therapeutic effect is uncertain.