【摘要】：目的探討麻疹并發(fā)閉塞性細支氣管炎的臨床特點。方法分析2012年3月—2014年3月河北省兒童醫(yī)院確診為麻疹并發(fā)閉塞性細支氣管炎的6例患兒的臨床資料,包括性別、月齡、臨床特點、血氣分析特點、肺功能檢查、影像學(xué)檢查、纖維支氣管鏡檢查、診療經(jīng)過及隨訪情況等。結(jié)果 6例患兒中男5例、女1例,發(fā)病月齡8~15個月。急性感染期病情嚴重,均表現(xiàn)為反復(fù)發(fā)熱、呼吸困難明顯;持續(xù)期以喘息、混合型呼吸困難為主要臨床表現(xiàn),以三凹征陽性、肺部聞及喘鳴音為主要體征。血氣分析均提示低氧血癥伴二氧化碳潴留,肺功能檢查提示小氣道阻塞性通氣功能障礙4例,混合性通氣功能障礙2例。肺CT表現(xiàn)為典型的"馬賽克灌注征"4例,肺間質(zhì)改變2例,支氣管擴張1例,過度充氣1例。治療方面急性感染期均給予持續(xù)正壓通氣輔助呼吸、免疫球蛋白、甲潑尼龍、抗感染等對癥治療,持續(xù)期口服小劑量阿奇霉素、潑尼松片、孟魯司特聯(lián)合布地奈德霧化吸入等治療。隨訪1.0~2.5年,6例患兒均未死亡,其中5例臨床癥狀、血氣分析、肺功能分別得到了一定程度的好轉(zhuǎn),1例生長發(fā)育遲緩、臨床癥狀無明顯改善。結(jié)論麻疹并發(fā)閉塞性細支氣管炎的患兒發(fā)病年齡較小,臨床表現(xiàn)以慢性咳嗽、喘息、反復(fù)呼吸道感染為主,肺CT以通氣不均勻、"馬賽克灌注征"為特點,血氣分析多提示Ⅱ型呼吸衰竭,肺功能檢查多見阻塞性通氣功能障礙,治療早期應(yīng)用激素、免疫球蛋白對預(yù)后有一定程度改善作用。
[Abstract]:Objective to investigate the clinical features of measles complicated with bronchiolitis obliterans. Methods the clinical data of 6 children with measles complicated with bronchiolitis obliterans in Hebei Children's Hospital from March 2012 to March 2014 were analyzed, including sex, age, clinical characteristics, blood gas analysis and pulmonary function examination. Imaging examination, fiberoptic bronchoscopy, diagnosis and treatment and follow-up. Results among 6 cases, 5 cases were male and 1 case female, the age of onset was 8 ~ 15 months. The symptoms of acute infection were severe, with repeated fever, dyspnea, wheezing, mixed dyspnea as the main clinical manifestation, positive triple concave sign, lung smell and wheezing sound as the main signs. Blood gas analysis showed that hypoxemia with carbon dioxide retention, pulmonary function examination showed small airway obstructive ventilation dysfunction in 4 cases, mixed ventilation dysfunction in 2 cases. CT showed typical "mosaic perfusion sign" in 4 cases, pulmonary interstitial change in 2 cases, bronchiectasis in 1 case, hyperinflation in 1 case. In the treatment of acute infection, all patients were given continuous positive pressure ventilation to assist breathing, immunoglobulin, methylprednisolone, anti-infection and other symptomatic treatment, the duration of oral administration of azithromycin, prednisone tablets, Montelukast combined with budesonide atomization inhalation and other treatment. During the follow-up period of 1.0 ~ 2.5 years, no death was found in 6 cases. Among them, 5 cases had clinical symptoms, blood gas analysis and lung function were improved to some extent, and 1 case had growth retardation and no obvious improvement in clinical symptoms. Conclusion the children with measles complicated with bronchiolitis obliterans have a younger age, the clinical manifestations are chronic cough, wheezing, recurrent respiratory tract infection, and CT is characterized by uneven ventilation and "mosaic perfusion sign". Blood gas analysis showed that type 鈪，

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