【摘要】 目的了解小儿闭塞性细支气管炎(BO)的临床特点。方法对近年本院临床诊断为BO的6例病例进行临床表现、胸部X线及高分辨CT、肺功能和治疗转归的回顾性分析。结果6例均表现为呼吸道感染后慢性咳嗽、喘息、气促,1例病程4周以上,其余5例病程8～16周以上。查体:均有呼吸急促,双肺闻及湿啰音、喘鸣音。X线胸片:肺内过度通气6例,斑片状磨玻璃影1例。胸部高分辨CT:斑片影5例,Mosaic灌注5例,支气管壁增厚2例。肺功能:6例均为阻塞性通气功能障碍,非可逆性,5例血气示氧分压降低。2例纤维支气管镜检查无特异性发现。6例患儿用支气管舒张剂治疗无效,随后均用激素治疗,3例已随访6～8个月,2例病情改善,肺内啰音消失,肺过度充气减轻,其中1例肺CTMosaic灌注有所好转,另1例肺CT无明显改善。第3例病情及肺CT均无明显改善。结论BO的临床表现以慢性咳嗽、喘息,肺内有喘鸣音为特点,对支气管舒张剂无反应。肺CT示:Mosaic灌注、支气管壁增厚等。X线胸片和纤维支气管镜检查无特异性。肺功能为阻塞性通气功能障碍,不可逆性。血气显示不同程度的低氧血症。BO的诊断主要依据典型的临床表现、肺部高分辨CT和肺功能检查。更多还原

【Abstract】 Objective To investigate the clinical features of pediatric bronchiolitis obliterans(BO). Method Clinical feature, chest X-ray, high-resolution computed tomography(HRCT), pulmonary function of six children with BO were retrospectively analyzed. Result All cases were after respiratory infection. Chronic cough,tachypnea and wheezing exist in all cases. The symptoms had lasted for at least 4 to 16 weeks before they came to our hospital. Crackles and wheezing were present in all the 6 cases. All cases had hyperinflation and one case had ground-glass opacity patches in chest X-ray. On pulmonary HRCT, patchy opacity and mosaic perfusion were seen in 5 cases, bronchial wall thicken was seen in 2 cases. All cases showed obstruction of small airway on pulmonary function tests, and were not responsive to bronchodilator therapy. Fiberoptic bronchoscopy of two case had no specific finding. Prednisone was used at a dose of 1 mg/(kg·d) in all cases. 3 cases were followed up for 6 to 8 month. The clinical condition of two cases were improved while the HRCT of one of them showed no improvement. The third case showed no improvement on both the clinical condition and the HRCT. Conclusion The clinical features of pediatric BO were chronic cough, tachypnea and wheezing, and crackles and wheezing on auscultation. Pulmonary function tests suggested obstruction of small airway and were not responsive to bronchodilator therapy. Pulmonary HRCT showed mosaic perfusion, bronchial wall thicken,etc. Chest X-ray and fiberoptic bronchoscopy had no specific finding.更多还原