婴幼儿喘息的诊治
合集下载
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
哮喘
同时存在哮喘而导致诊断过程复杂化
治疗
流感嗜血杆菌、肺炎链球菌等治疗 疗程3-6周
Wheeze in preschool age is
associated with pulmonaryΒιβλιοθήκη Baidu
bacterial infection and resolves
after BACKGROUND: antibiotic therapy Neonates with airways colonized by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis are at increased risk for recurrent wheeze which may resemble asthma early in life. It is not clear whether chronic colonization by these pathogens is causative for severe persistent wheeze in some preschool children and whether these children might benefit from antibiotic treatment. We assessed the relevance of bacterial colonization and chronic airway infection in preschool children with severe persistent wheezing and evaluated the outcome of long-time antibiotic treatment on the clinical course in such children. METHODOLOGY/PRINCIPAL FINDINGS:
Preschool children (n = 42) with severe persistent wheeze but no symptoms of acute pulmonary infection were investigated by bronchoscopy and bronchoalveolar lavage (BAL). Differential cell counts and microbiological and virological analyses were performed on BAL samples. Patients diagnosed with bacterial infection were treated with antibiotics for 2-16 weeks (n = 29). Of the 42 children with severe wheezing, 34 (81%) showed a neutrophilic inflammation and 20 (59%) of this subgroup had elevated bacterial counts (≥ 10⁴ colony forming units per milliliter) suggesting infection. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were the most frequently isolated species. After treatment with appropriate antibiotics 92% of patients showed a marked improvement of symptoms upon follow-up examination.
PLoS One. 2011;6(11):e27913. Epub 2011 Nov 29.
闭塞性细支气管炎 （Bronchiolitis
Obliterans)
北京儿童医院 赵顺英
定义
闭塞性细支气管炎（Bronchiolitis obliterans）是与细支气管炎症性损伤相 关，导致管腔闭塞的慢性气流阻塞综合 征。
婴幼儿喘息的诊治
北京儿童医院 赵顺英
首次喘息诊断
毛细 （病毒感染性喘息）
喘支
哮喘首次发作
肺炎
支气管异物
支气管畸形合并感染
迁延或持续或反复喘息诊断
✓ 首次病毒感染性喘息治疗不彻底 ✓ 哮喘 ✓ 胃食道反流 ✓ 气道畸形 ：气管-支气管软化、狭窄 ✓ 血管发育畸形: 双主动脉弓等 ✓ 肺结核: 肿大淋巴结压迫气道或支气管结核 ✓ 支气管异物 ✓ 免疫功能缺陷合并气道、肺部反复感染 ✓ 闭塞性细支气管炎* ✓ 持续性细菌性支气管（细支气管）炎*
CONCLUSIONS/SIGNIFICANCE: Chronic bacterial infections are relevant in a subgroup of preschool children with persistent wheezing and such children benefit significantly from antibiotic therapy.
支气管异物
气道狭窄
支气管畸形和血管压迫
首次病毒感染性喘息治疗不彻底
病毒感染性气道高反应持续 合并感染: 肺炎和持续性细菌性支气管炎 平喘药物停用后反复
哮喘早期考虑
具有哮喘特征：发作性、可逆性，重复性 喘息病情重： 家族或个人过敏史 除外其他引起喘息性疾病
临床表现
发病年龄：2岁以内常见 诱因：急性上下呼吸道感染 表现：持续性湿性咳嗽、喘息
吸气相和呼气相粗痰鸣音 而不是典型的喘鸣
影像学表现
可以正常 最常见的异常表现为支气管壁增厚 斑片片影 可有支气管扩张
支气管镜表现
传导气道分泌物多，多呈脓性 粘膜水肿 气道闭塞
支气管内膜炎
肺泡灌洗液细胞学分析，中性粒细胞为主
病原学
肺炎链球菌、流感嗜血杆菌最常见 卡他汉菌、其他链球菌 G- 杆菌
并存疾病
同时存在哮喘而导致诊断过程复杂化
治疗
流感嗜血杆菌、肺炎链球菌等治疗 疗程3-6周
Wheeze in preschool age is
associated with pulmonaryΒιβλιοθήκη Baidu
bacterial infection and resolves
after BACKGROUND: antibiotic therapy Neonates with airways colonized by Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis are at increased risk for recurrent wheeze which may resemble asthma early in life. It is not clear whether chronic colonization by these pathogens is causative for severe persistent wheeze in some preschool children and whether these children might benefit from antibiotic treatment. We assessed the relevance of bacterial colonization and chronic airway infection in preschool children with severe persistent wheezing and evaluated the outcome of long-time antibiotic treatment on the clinical course in such children. METHODOLOGY/PRINCIPAL FINDINGS:
Preschool children (n = 42) with severe persistent wheeze but no symptoms of acute pulmonary infection were investigated by bronchoscopy and bronchoalveolar lavage (BAL). Differential cell counts and microbiological and virological analyses were performed on BAL samples. Patients diagnosed with bacterial infection were treated with antibiotics for 2-16 weeks (n = 29). Of the 42 children with severe wheezing, 34 (81%) showed a neutrophilic inflammation and 20 (59%) of this subgroup had elevated bacterial counts (≥ 10⁴ colony forming units per milliliter) suggesting infection. Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis were the most frequently isolated species. After treatment with appropriate antibiotics 92% of patients showed a marked improvement of symptoms upon follow-up examination.
PLoS One. 2011;6(11):e27913. Epub 2011 Nov 29.
闭塞性细支气管炎 （Bronchiolitis
Obliterans)
北京儿童医院 赵顺英
定义
闭塞性细支气管炎（Bronchiolitis obliterans）是与细支气管炎症性损伤相 关，导致管腔闭塞的慢性气流阻塞综合 征。
婴幼儿喘息的诊治
北京儿童医院 赵顺英
首次喘息诊断
毛细 （病毒感染性喘息）
喘支
哮喘首次发作
肺炎
支气管异物
支气管畸形合并感染
迁延或持续或反复喘息诊断
✓ 首次病毒感染性喘息治疗不彻底 ✓ 哮喘 ✓ 胃食道反流 ✓ 气道畸形 ：气管-支气管软化、狭窄 ✓ 血管发育畸形: 双主动脉弓等 ✓ 肺结核: 肿大淋巴结压迫气道或支气管结核 ✓ 支气管异物 ✓ 免疫功能缺陷合并气道、肺部反复感染 ✓ 闭塞性细支气管炎* ✓ 持续性细菌性支气管（细支气管）炎*
CONCLUSIONS/SIGNIFICANCE: Chronic bacterial infections are relevant in a subgroup of preschool children with persistent wheezing and such children benefit significantly from antibiotic therapy.
支气管异物
气道狭窄
支气管畸形和血管压迫
首次病毒感染性喘息治疗不彻底
病毒感染性气道高反应持续 合并感染: 肺炎和持续性细菌性支气管炎 平喘药物停用后反复
哮喘早期考虑
具有哮喘特征：发作性、可逆性，重复性 喘息病情重： 家族或个人过敏史 除外其他引起喘息性疾病
临床表现
发病年龄：2岁以内常见 诱因：急性上下呼吸道感染 表现：持续性湿性咳嗽、喘息
吸气相和呼气相粗痰鸣音 而不是典型的喘鸣
影像学表现
可以正常 最常见的异常表现为支气管壁增厚 斑片片影 可有支气管扩张
支气管镜表现
传导气道分泌物多，多呈脓性 粘膜水肿 气道闭塞
支气管内膜炎
肺泡灌洗液细胞学分析，中性粒细胞为主
病原学
肺炎链球菌、流感嗜血杆菌最常见 卡他汉菌、其他链球菌 G- 杆菌
并存疾病