婴幼儿喘息的诊治

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1、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*气道狭窄支气管异物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

2、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持续性细菌性支气管炎很多诊断名词：（1）慢性化脓性肺疾病（ChronicSuppurativeLungDisease）（2）持续性支气管内膜感染(PersistentEndobrobchialInfections)（3）迁延性支气管炎（ProtractedBronchitis）（4）慢性支气管炎（ChronicBronchitis）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

3、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WheezeinpreschoolageisassociatedwithpulmonarybacterialinfectionandresolvesafterantibiotictherapyBACKGROUND:Ne

4、onateswithairwayscolonizedbyHaemophilusinfluenzae,StreptococcuspneumoniaeorMoraxellacatarrhalisareatincreasedriskforrecurrentwheezewhichmayresembleasthmaearlyinlife.Itisnotclearwhetherchroniccolonizationbythesepathogensiscausativeforseverepersistentwheezeinsomepreschoo

5、lchildrenandwhetherthesechildrenmightbenefitfromantibiotictreatment.Weassessedtherelevanceofbacterialcolonizationandchronicairwayinfectioninpreschoolchildrenwithseverepersistentwheezingandevaluatedtheoutcomeoflong-timeantibiotictreatmentontheclinicalcourseinsuchchildre

6、n.METHODOLOGY/PRINCIPALFINDINGS:Preschoolchildren(n = 42)withseverepersistentwheezebutnosymptomsofacutepulmonaryinfectionwereinvestigatedbybronchoscopyandbronchoalveolarlavage(BAL).DifferentialcellcountsandmicrobiologicalandvirologicalanalyseswereperformedonBALsamples.

7、Patientsdiagnosedwithbacterialinfectionweretreatedwithantibioticsfor2-16weeks(n = 29).Ofthe42childrenwithseverewheezing,34(81%)showedaneutrophilicinflammationand20(59%)ofthissubgrouphadelevatedbacterialcounts(≥10⁴colonyformingunitspermilliliter)suggestinginfection.Haem

8、ophilusinfluenzae,StreptococcuspneumoniaeandMoraxellacatarrhaliswerethemostfrequentlyisolatedspecies.Aftertreatmentwi