本文選題：間質(zhì)性肺疾病 + 臨床表現(xiàn)　； 參考：《大連醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的分析兒童間質(zhì)性肺疾病的臨床表現(xiàn)、胸部CT征象、肺功能變化及支氣管鏡鏡下特點(diǎn)，為兒童間質(zhì)性肺疾病的診斷和治療提供臨床思路。 方法采用回顧性分析的方法，選擇2011年1月至2012年6月在大連市兒童醫(yī)院呼吸病房住院，符合納入標(biāo)準(zhǔn)、臨床診斷間質(zhì)性肺疾病的患者49例，總結(jié)分析其臨床表現(xiàn)、胸部CT征象、肺功能變化及支氣管鏡鏡下特點(diǎn)，并將各項(xiàng)結(jié)果記錄至病例登記表。 結(jié)果 1.在49例兒童間質(zhì)性肺疾病患者中，男性患者占75.5%；2歲的患者占61.2%；病因不明者占57.2%，和感染相關(guān)者占36.7%，和奶汁吸入相關(guān)者占6.1%。 2.在49例兒童間質(zhì)性肺疾病患者中，45例患者進(jìn)行了血清病毒抗體測(cè)定，病毒抗體的陽(yáng)性率為17.8%；其中呼吸道合胞病毒感染者2例，腺病毒感染者5例，副流感病毒感染者1例。41例患者進(jìn)行了肺炎支原體抗體測(cè)定，肺炎支原體抗體的陽(yáng)性率為4.9%。22例患者進(jìn)行了支氣管肺泡灌洗液細(xì)菌培養(yǎng)，灌洗液細(xì)菌培養(yǎng)的陽(yáng)性率為36.4%，其中肺炎鏈球菌感染者1例，流感嗜血桿菌感染者3例，大腸埃希菌感染者2例，鮑氏不動(dòng)桿菌感染者2例。所有病原學(xué)檢測(cè)陽(yáng)性的患者均為單一病原體感染。 3.在49例兒童間質(zhì)性肺疾病患者中，，臨床表現(xiàn)為咳嗽者占98.0%；活動(dòng)后呼吸困難者占93.9%；低至中等程度發(fā)熱者占51.0%。肺部聽(tīng)診聞及濕Up音者占57.1%；肺部聽(tīng)診聞及喘鳴音者占53.1%；肺部聽(tīng)診未見(jiàn)異常者占28.6%。 4.49例兒童間質(zhì)性肺疾病患者均進(jìn)行了胸部CT檢查，胸部CT出現(xiàn)磨玻璃影者占93.9%；出現(xiàn)網(wǎng)狀陰影者占46.9%；伴肺不張者占2.0%；伴胸膜增厚者占2.0%；伴實(shí)變影者占36.7%；伴氣腫者占8.2%。 5.在49例兒童間質(zhì)性肺疾病患者中，32例患者進(jìn)行了肺功能檢查，均表現(xiàn)不同程度的肺通氣功能障礙；其中阻塞性通氣功能障礙者占93.8%；混合性通氣功能障礙者占6.2%。 6.在49例兒童間質(zhì)性肺疾病患者中，22例患者進(jìn)行了支氣管鏡檢查，支氣管鏡鏡下表現(xiàn)粘膜輕-中度充血、腫脹，管嵴輕-中度增寬，管口輕-中度減小的患者占100%；支氣管鏡鏡下見(jiàn)黃白色粘稠分泌物、痰塊樣分泌物、壞死物者占86.4%，奶汁樣分泌物者占13.6%。 結(jié)論 1.兒童間質(zhì)性肺疾病以男性患者為主，2歲以?xún)?nèi)好發(fā)，57.2%的患者病因不明，36.7%的患者病因和感染相關(guān)，6.1%的患者病因和奶汁吸入相關(guān)。 2.兒童間質(zhì)性肺疾病中90%以上的患者出現(xiàn)咳嗽、活動(dòng)后呼吸困難；50%以上的患者肺部聽(tīng)診可聞及濕Up音、喘鳴音。 3.兒童間質(zhì)性肺疾病中90%以上的患者胸部CT呈磨玻璃影，近1/2的患者呈網(wǎng)狀陰影；約1/3的患者伴實(shí)變影。 4.兒童間質(zhì)性肺疾病中90%以上的患者肺功能表現(xiàn)為阻塞性通氣功能障礙。 5.兒童間質(zhì)性肺疾病中100%的患者支氣管鏡鏡下表現(xiàn)粘膜輕-中度充血、腫脹，管嵴輕-中度增寬，管口輕-中度減��；86.4%的患者鏡下可見(jiàn)黃白色粘稠分泌物、痰塊樣分泌物、壞死物；13.6%的患者鏡下可見(jiàn)奶汁樣分泌物。
[Abstract]:Objective to analyze the clinical manifestations of interstitial lung disease in children, the CT signs of the chest, the changes of lung function and the characteristics of bronchoscopy, so as to provide clinical ideas for the diagnosis and treatment of interstitial lung disease in children.
Methods a retrospective analysis was used to select 49 patients who were hospitalized in the respiratory ward of Dalian children's Hospital from January 2011 to June 2012. The clinical manifestations, chest CT signs, pulmonary function changes and bronchoscopy characteristics were summarized and analyzed, and the results were recorded to the cases. Take a note.
Result
1. among 49 children with interstitial lung disease, 75.5% were male, 61.2% were 2 years of age, 57.2% were unknown, 36.7% were associated with infection, and 6.1%. associated with milk inhalation accounted for the proportion of patients.
2. in 49 cases of children with interstitial lung disease, 45 patients had serum antibody test, the positive rate of virus antibody was 17.8%, of which 2 cases of respiratory syncytial virus infection, 5 cases of adenovirus infection, 1 cases of parainfluenza virus infection in.41 patients were tested for the antibody of Mycoplasma pneumoniae and the positive rate of Mycoplasma pneumoniae antibody. The bacterial culture of bronchoalveolar lavage fluid was carried out for 4.9%.22 patients. The positive rate of bacterial culture in the lavage liquid was 36.4%, of which 1 cases were Streptococcus pneumoniae, 3 cases of Haemophilus influenzae, 2 cases of Escherichia coli infection and 2 cases of Acinetobacter baumannii infection. All the patients with positive detection were single pathogen infection.
3. among 49 children with interstitial lung disease, 98% were coughs, 93.9% were dyspnea after activity, 57.1% of 51.0%. pulmonary auscultation and wet Up sound, 53.1% of pulmonary auscultation and wheezing, and no 28.6%. in pulmonary auscultation.
4.49 cases of children with interstitial lung disease were examined by chest CT, 93.9% with glass shadow in chest, 46.9% with reticular shadow, 2% with non open lung, 2% with pleural thickening, 36.7% with pleural thickening, 36.7% with real change, and 8.2%. with emphysema.
5. in 49 cases of children with interstitial lung disease, 32 patients had pulmonary function examination, which showed different degrees of pulmonary ventilation dysfunction, of which 93.8% were obstructive ventilatory dysfunction, and mixed ventilation dysfunction accounted for 6.2%..
6. in 49 cases of children with interstitial lung disease, 22 patients underwent bronchoscopy. Bronchoscopy showed mild to moderate hyperemia, swelling, light and medium width of tubular ridge, 100% of light to moderate decrease in the mouth, and bronchoscopy with yellow white sticky secretions, sputum like secretions, 86.4% necrosis, milk sample. 13.6%.
conclusion
1. children with interstitial lung disease were mainly male patients, 2 years old, 57.2% of the patients were unknown, 36.7% of the patients were associated with the cause of infection, and 6.1% of the patients were associated with milk inhalation.
2. in children with interstitial lung disease, more than 90% of the patients developed cough, breathing difficulties after exercise, and 50% of the patients had lung auscultation audible and wet Up sounds and wheezing sounds.
3. of the children with interstitial lung disease, more than 90% of the patients had CT in the chest, and nearly 1/2 showed a mesh shadow. About 1/3 of the patients had consolidation.
4. of the children with interstitial lung disease, more than 90% of the patients had obstructive pulmonary dysfunction.
Of 5. children with interstitial lung disease, 100% of the patients showed mild to moderate hyperemia, swelling, light and medium width of tubular ridge, light to moderate decrease in the canal, and 86.4% of the patients were visible with yellow and white mucous secretions, sputum like secretions, and bad dead objects, and 13.6% of the patients showed milk secretion.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R725.6

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 牟京輝 ,陳慧中 ,曹力 ,袁新宇 ,關(guān)立夫;兒童間質(zhì)性肺疾病疾病譜探討和診斷方法評(píng)估[J];臨床兒科雜志;2003年09期

2 張海鄰;兒童間質(zhì)性肺疾病診斷和治療[J];臨床兒科雜志;2003年09期

3 劉秀云;周春菊;彭蕓;江載芳;;29例小兒間質(zhì)性肺疾病臨床、放射及病理分析[J];臨床兒科雜志;2012年02期

4 劉秀云;;兒童間質(zhì)性肺疾病的分類(lèi)和診斷程序[J];臨床兒科雜志;2012年02期

本文編號(hào)：1847090