有创机械通气重症肺炎患儿感染闭塞性毛细支气管炎影响因素分析
|
摘要
目的探讨有创机械通气重症肺炎患儿感染后闭塞性毛细支气管炎的临床特点与影响因素。方法回顾性分析2010年1月-2017年6月于医院进行治疗的有创机械通气重症肺炎患儿87例的临床资料,分析患儿感染后闭塞性毛细支气管炎情况,对患儿的临床特点,病原菌情况进行分析,并探讨有创机械通气重症肺炎患儿感染后闭塞性毛细支气管炎的影响因素。结果 87例患儿中感染后出现闭塞性毛细支气管炎32例,其中喘息28例,持续咳嗽与运动不耐受均各21例,肺部哮鸣音25例;87例患儿均出现阻塞性通气功能障碍,高分辨率CT检查结果中马赛克灌注征26例;15例闭塞性毛细支气管炎患儿的病原体培养阳性;发病后就诊时间、治疗初期使用激素、有创机械通气维持时间是有创机械通气患儿感染后发生闭塞性毛细支气管炎的影响因素(P<0.05)。结论闭塞性毛细支气管炎患儿的临床表现主要集中在呼吸及循环系统的异常,多种病原体均可导致该种疾病的发生,建议临床针对影响因素采用针对性的措施进行干预。
OBJECTIVE To investigate the clinical features and risk factors of obliterative bronchiolitis in children with severe pneumonia after invasive mechanical ventilation.METHODS A retrospective analysis was conducted for87 children with severe pneumonia undergoing mechanical ventilation who were treated in the hospital from Jan.2010 to Jun.2017.The condition of occlusive bronchiolitis after infection in the children was analyzed.The clinical characteristics of the children and the pathogens were analyzed.The influencing factors of obliterative bronchiolitis after infection in children with severe pneumonia undergoing invasive mechanical ventilation were investigated.RESULTS There were 32 cases of obliterative bronchiolitis,28 cases of wheezing,21 cases of persistent cough and exercise intolerance,and 25 cases of pulmonary wheezing after infection in the 87 children.Obstructive ventilatory dysfunction was found in all 87 cases,and the mosaic perfusion sign was found in 26 cases according to high-resolution CT examination results.15 cases of obliterative bronchiolitis patients were positive for pathogen culture.The influencing factors of obliterative bronchiolitis in children infected with invasive mechanical ventilation were the time of consultation after the onset of the disease,the use of hormones at the initial stage of treatment and the maintenance time of invasive mechanical ventilation(P<0.05).CONCLUSIONThe clinical manifestations of children with obliterative bronchiolitis were mainly the abnormalities of respiratory and circulatory systems.A variety of pathogens can lead to the occurrence of this disease.It is suggested that specific measures should be taken to intervene in clinic according to the influencing factors.
OBJECTIVE To investigate the clinical features and risk factors of obliterative bronchiolitis in children with severe pneumonia after invasive mechanical ventilation.METHODS A retrospective analysis was conducted for87 children with severe pneumonia undergoing mechanical ventilation who were treated in the hospital from Jan.2010 to Jun.2017.The condition of occlusive bronchiolitis after infection in the children was analyzed.The clinical characteristics of the children and the pathogens were analyzed.The influencing factors of obliterative bronchiolitis after infection in children with severe pneumonia undergoing invasive mechanical ventilation were investigated.RESULTS There were 32 cases of obliterative bronchiolitis,28 cases of wheezing,21 cases of persistent cough and exercise intolerance,and 25 cases of pulmonary wheezing after infection in the 87 children.Obstructive ventilatory dysfunction was found in all 87 cases,and the mosaic perfusion sign was found in 26 cases according to high-resolution CT examination results.15 cases of obliterative bronchiolitis patients were positive for pathogen culture.The influencing factors of obliterative bronchiolitis in children infected with invasive mechanical ventilation were the time of consultation after the onset of the disease,the use of hormones at the initial stage of treatment and the maintenance time of invasive mechanical ventilation(P<0.05).CONCLUSIONThe clinical manifestations of children with obliterative bronchiolitis were mainly the abnormalities of respiratory and circulatory systems.A variety of pathogens can lead to the occurrence of this disease.It is suggested that specific measures should be taken to intervene in clinic according to the influencing factors.
引文
[1] Yu J.Postinfectious bronchiolitis obliterans in children:lessons from bronchiolitis obliterans after lung transplantation and hematopoietic stem cell transplantation[J].Korean J Pediatr,2015,58(12):459-465.
[2] Colom AJ,Maffey A,Garcia BF,et al.Pulmonary function of apediatric cohort of patients with post-infectious bronchiolitis obliterans:a long term follow-up[J].Thorax,2015,70(2):169-174.
[3] Tanou K,Xaidara A,Kaditis AG.Efficacy of pulse methylprednisolone in a pediatric case of postinfectious bronchiolitis obliterans[J].Pediatr Pulmonol,2015,50(5):E13-E16.
[4] Belousov D,Gorbunova V,Orlov S,et al.Pharmacoeconomic analysis of afatinib as 1st-line treatment of metastatic nonsmall cell lung cancer with Del19 mutation of Egfr gene[J].Value Heal,2015,18(7):A458-A459.
[5] Krustrup D,Iversen M,Martinussen T,et al.The number of FoxP3+cells in transbronchial lung allograft biopsies does not predict bronchiolitis obliterans syndrome within the first five years after transplantation[J].Clin Transplant,2015,29(3):179-184.
[6]中华医学会儿科学分会呼吸学组.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7]中华医学会儿科学分会呼吸学组.儿童闭塞性细支气管炎的诊断与治疗建议[J].中华儿科杂志,2012,50(10):743-745.
[8]刘耘,王淑红,马冬均.小儿闭塞性毛细支气管炎14例临床分析[J].新疆医科大学学报,2015(6):754-755.
[9]利汉其,廖友明,罗翠云,等.多层螺旋CT三维重建在小儿气喘可疑病因诊断中的价值[J].广东医学,2015,(5):723-725.
[10] Kapila A,Baz MA,Valentine VG,et al.Reliability of diagnostic criteria for bronchiolitis obliterans syndrome after lung transplantation:a survey[J].J Heart Lung Transplant,2015,34(1):65-74.
[11] Abedin S,Yanik GA,Braun T,et al.Predictive value of bronchiolitis obliterans syndrome stage 0p in chronic graft-versus-host disease of the Lung[J].Biol Blood Marrow Transplant,2015,21(6):1127-1131.
[12] Tomikawa SO,Rodrigues JC.Current research on pediatric patients with bronchiolitis obliterans in Brazil[J].Intractable Rare Dise Res,2015,4(1):7-11.
[13] Robinson D,Spencer H,Aurora P,et al.Impact of lung function interpretation approach on pediatric bronchiolitis obliterans syndrome diagnosis after lung transplantation[J].J Heart Lung Transplant,2015,34(8):1082-1088.
[14] Jo KW,Yoon S,Song JW,et al.The efficacy of prophylactic azithromycin on bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation[J].Int J Hematol,2015,102(3):357-363.
[15]李茜梅,吴素玲,石彩晓,等.毛细支气管炎患儿医院感染危险因素分析[J].中华医院感染学杂志,2015,25(4):934-936.
[16] Giubergia V,Salim M,Fraga J,et al.Post-infectious bronchiolitis obliterans and mannose-binding lectin insufficiency in Argentinean children[J].Respirology,2015,20(6):982-986.
[17] Kauke T,Kneidinger N,Martin B,et al.Bronchiolitis obliterans syndrome due to donor-specific HLA-antibodies[J].Tiss Antig,2015,86(3):178-185.
[18] Benden,C.What we expected all along:bronchiolitis obliterans syndrome is not specific for bronchiolitis obliterans in pediatric lung transplantation![J].J Heart Lung Transplant,2015,34(4):501-502.
[19] Mimura T,Walker N,Aoki Y,et al.Local,origin of mesenchymal cells in a murine orthotopic lung transplantation model of bronchiolitis obliterans[J].Am J Pathol,2015,185(6):1564-1574.
[2] Colom AJ,Maffey A,Garcia BF,et al.Pulmonary function of apediatric cohort of patients with post-infectious bronchiolitis obliterans:a long term follow-up[J].Thorax,2015,70(2):169-174.
[3] Tanou K,Xaidara A,Kaditis AG.Efficacy of pulse methylprednisolone in a pediatric case of postinfectious bronchiolitis obliterans[J].Pediatr Pulmonol,2015,50(5):E13-E16.
[4] Belousov D,Gorbunova V,Orlov S,et al.Pharmacoeconomic analysis of afatinib as 1st-line treatment of metastatic nonsmall cell lung cancer with Del19 mutation of Egfr gene[J].Value Heal,2015,18(7):A458-A459.
[5] Krustrup D,Iversen M,Martinussen T,et al.The number of FoxP3+cells in transbronchial lung allograft biopsies does not predict bronchiolitis obliterans syndrome within the first five years after transplantation[J].Clin Transplant,2015,29(3):179-184.
[6]中华医学会儿科学分会呼吸学组.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7]中华医学会儿科学分会呼吸学组.儿童闭塞性细支气管炎的诊断与治疗建议[J].中华儿科杂志,2012,50(10):743-745.
[8]刘耘,王淑红,马冬均.小儿闭塞性毛细支气管炎14例临床分析[J].新疆医科大学学报,2015(6):754-755.
[9]利汉其,廖友明,罗翠云,等.多层螺旋CT三维重建在小儿气喘可疑病因诊断中的价值[J].广东医学,2015,(5):723-725.
[10] Kapila A,Baz MA,Valentine VG,et al.Reliability of diagnostic criteria for bronchiolitis obliterans syndrome after lung transplantation:a survey[J].J Heart Lung Transplant,2015,34(1):65-74.
[11] Abedin S,Yanik GA,Braun T,et al.Predictive value of bronchiolitis obliterans syndrome stage 0p in chronic graft-versus-host disease of the Lung[J].Biol Blood Marrow Transplant,2015,21(6):1127-1131.
[12] Tomikawa SO,Rodrigues JC.Current research on pediatric patients with bronchiolitis obliterans in Brazil[J].Intractable Rare Dise Res,2015,4(1):7-11.
[13] Robinson D,Spencer H,Aurora P,et al.Impact of lung function interpretation approach on pediatric bronchiolitis obliterans syndrome diagnosis after lung transplantation[J].J Heart Lung Transplant,2015,34(8):1082-1088.
[14] Jo KW,Yoon S,Song JW,et al.The efficacy of prophylactic azithromycin on bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation[J].Int J Hematol,2015,102(3):357-363.
[15]李茜梅,吴素玲,石彩晓,等.毛细支气管炎患儿医院感染危险因素分析[J].中华医院感染学杂志,2015,25(4):934-936.
[16] Giubergia V,Salim M,Fraga J,et al.Post-infectious bronchiolitis obliterans and mannose-binding lectin insufficiency in Argentinean children[J].Respirology,2015,20(6):982-986.
[17] Kauke T,Kneidinger N,Martin B,et al.Bronchiolitis obliterans syndrome due to donor-specific HLA-antibodies[J].Tiss Antig,2015,86(3):178-185.
[18] Benden,C.What we expected all along:bronchiolitis obliterans syndrome is not specific for bronchiolitis obliterans in pediatric lung transplantation![J].J Heart Lung Transplant,2015,34(4):501-502.
[19] Mimura T,Walker N,Aoki Y,et al.Local,origin of mesenchymal cells in a murine orthotopic lung transplantation model of bronchiolitis obliterans[J].Am J Pathol,2015,185(6):1564-1574.