天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (8): 881-884.doi: 10.11958/20170723

• 临床研究 • 上一篇    下一篇

需有创通气的重症肺炎患儿合并感染后闭塞性毛细 支气管炎的临床特点及危险因素分析

李晓卿   

  1. 天津市儿童医院 PICU （邮编 300134）
  • 收稿日期:2017-06-21 修回日期:2017-07-06 出版日期:2017-08-15 发布日期:2017-08-15
  • 作者简介:李晓卿 （1975）， 女， 硕士， 副主任医师， 主要从事儿科危重症的研究

The clinical features and risk factors of children with post-infectious bronchiolitis obliterans treated with invasive mechanical ventilation because of severe pneumonia

LI Xiao-qing   

  1. Department of PICU, Tianjin Children’ s Hospital, Tianjin 300134, China
  • Received:2017-06-21 Revised:2017-07-06 Published:2017-08-15 Online:2017-08-15

PDF (PC)

3686

摘要： 目的 探讨需有创通气的重症肺炎患儿合并感染后闭塞性毛细支气管炎 （PBO） 的临床特点及危险因素， 为临床早期诊断、 早期治疗， 改善 PBO 患儿的预后提供临床参考。方法 收集 2010 年 10 月—2015 年 12 月因重症 肺炎需有创通气治疗入住我院儿童重症监护病房 （PICU） 并最终诊断为 PBO 的患儿为 PBO 组， 抽取同期住院的需有 创通气的重症肺炎患儿作为对照组。对 2 组患儿的一般特征、 临床表现、 就诊时间、 治疗情况、 病原学分布及相关检 查结果等进行统计分析。采用 SAS 9.3 统计分析软件进行统计学处理。结果 共 73 例患儿纳入研究， 男 49 例， 女 24 例， 年龄 1~36 个月， 中位 8（4， 12）个月。其中 PBO 组 30 例， 对照组 43 例。喘息（27 例， 90.0%）、 持续咳嗽（22 例， 73.3%）、 运动不耐受（22 例， 73.3%）是 PBO 患儿的主要临床表现， 患儿的体征以哮鸣音（24 例， 80.0%）、 湿啰音 （21 例， 70.0%）为主。肺 CT 以马赛克灌注征（25 例， 83.3%）最为突出； 超过 2/3 的患儿肺功能中重度异常。PBO 组 患儿病原学检出率为 50%， 以病毒为主， 其中呼吸道合胞病毒 4 例、 流感病毒 1 例、 麻疹病毒 2 例、 腺病毒 4 例。多 因素 Logistic 回归分析显示， 病初用激素（OR=8.515， 95%CI： 1.948~37.224）、 机械通气时间长（OR=1.116， 95%CI： 1.031~1.327）、 就诊时间晚（OR=1.114， 95%CI： 1.010~1.227）是发生 PBO 的危险因素。结论 就诊时间晚、 病初用激 素且机械通气时间长的重症肺炎患儿一旦出现喘息、 持续咳嗽、 运动不耐受、 肺内哮鸣音和/或湿啰音持续存在等情 况， 应尽早行 PBO 的相关检查以明确诊断， 早期治疗。

关键词: 细支气管炎, 闭塞性, 肺炎, 危险因素, 儿童, 感染后闭塞性毛细支气管炎, 有创通气, 临床特点

Abstract: Objective To summarize the clinical features and risk factors of children with post-infectious bronchiolitis obliterans (PBO), who were treated with invasive mechanical ventilation because of severe pneumonia, and to provide clinical reference for early diagnosis, early treatment and improvement of prognosis of pediatric patients with PBO. Methods The pediatric patients treated with invasive mechanical ventilation because of severe pneumonia, who were hospitalized in PICU of Tianjin Children’ s Hospital from October 2010 to December 2015 were included in this study. The pediatric patients who were diagnosed with PBO were used as the observation group. The general characteristics, clinical presentation, treatment time, treatment results, distribution of pathogens and relevant laboratory examination results were analyzed by using SAS 9.3 statistical software. Results A total of 73 pediatric patients were included in this study, including 49 male and 24 female, and their mean age was 8 months (P25-P75: 4-12), the minimum age was 1 month and the maximum age was 36 months. They were divided into PBO group (n=30) and control group (n=43). It was found that wheezing (27 cases, 90.0% ), persistent cough (22 cases, 73.3%) and exercise intolerance (22 cases, 73.3%) were the main clinical symptoms in PBO group. Results of physical examination showed wheeze (24 cases, 80.0% ) and crackles (21 cases, 70.0% ). Mosaic perfusion (25 cases, 83.3%) was the most prominent sign in lung CT scan. More than 2/3 of the pediatric patients were found moderate and severe pulmonary dysfunction. Pathogen detection rate was 50% in PBO group, and virus was prevalent (respiratory syncytial virus 4 cases, influenza virus 1 case, measles virus 2 cases and adenovirus 4 cases). The results of Logistic multivariate regression analysis showed that the risk factors included using corticosteroids at the beginning of disease (OR=8.515, 95%CI: 1.948- 37.224), prolonged mechanical ventilation (OR=1.116, 95%CI: 1.031-1.327) and postponing clinic time (OR=1.114, 95%CI:1.010- 1.227). Conclusion Once the severe pneumonia children, with the risk factors of using corticosteroids at the beginning of disease, prolonged invasive mechanical ventilation and postponing clinic time, are found the wheezing, persistent cough and exercise intolerance, and persisting wheeze and/or crackles, the PBO relevant examination should be executed as soon as possible to diagnosis and treatment.

Key words: bronchiolitis obliterans, pneumonia, risk factors, child, post-infectious bronchiolitis obliterans, invasive mechanical ventilation, clinical features