Clinical Analysis Of 95 Cases Of Bronchitis Obliterans In Children

Objectives:To study the clinical characteristics and treatment of 95 cases of bronchitis obliterans and to improve the understanding of bronchitis obliterans.Methods:From January 2018 to December 2019,95 cases diagnosed as bronchitis obliterans by bronchoscopy in the Second Pediatric Respiratory Department of the First Hospital of Jilin University were included in this retrospective study,to collect the medical records of these children and to analyze the clinical characteristics and treatment of bronchitis obliterans.Results:1.General conditions:Men 61,female 34,age 16 months～15 years,average age(6.33±3.51)years.1～3y:21cases(22.1%),3～6y:40cases(26.6%),>6y:34cases(35.8%).The proportion of boys with bronchitis obliterans in different ages groups is higher.The hospitalization time was 3～40 days,with an average of 10.3±8.6 days.2.Clinical manifestations:Children had different degrees of cough,fever and dyspnea.Cough,95 cases,Cough course 10 days to 12 months,Cough more than 4weeks 27 cases;Fever 76,Heat peak up to 41℃,Heat course 1～60 days,The median was 10 days;wheezing in 21 cases.Sign:There were 62 cases(65.3%)of lung moist rales,33 cases(34.7%)of diminished breath-sounds and 16 cases of caudex(16.8%).3.Etiology:There were 57 cases of MP infection in 60 children in acute phase occlusive bronchitis group.The virus is most commonly infected with adenovirus,11 cases.MP CP accouted for the largest proportion,The main mixed bacteria infection pathogens included 1 case mycoplasma pneumoniae mixed Streptococcus pneumoniae and Haemophilus influenzae,1case mycoplasma pneumoniae mixed Haemophilus influenzae,1case mycoplasma pneumoniae and chlamydia pneumoniae mixed Streptococcus pneumoniae,1case mycoplasma pneumoniae mixed Baumannii,1case mycoplasma pneumoniae and chlamydia pneumoniae mixed Pseudomonas putida,1case MP mixed Enterobacter cloacae.Mycoplasma pneumoniae,Chlamydia pneumoniae mixed fungal infection:2 cases MP mixed Aspergillus fumigatus,1case mycoplasma pneumoniae and chlamydia pneumoniae mixed Candida albicans.Retrospective history of chronic occlusive bronchitis group identified 17 cases of pathogenic infection,including 10 cases of simple severe MP infection,4 cases of simple severe adenovirus infection,2 cases of MP mixed adenovirus severe infection,1case cytomegalovirus,parvovirus B19 infection.16 cases of chronic bronchitis obliterans with unclear pathogen description.Secondary infection of bronchitis obliterans in chronic group:MP 8 cases,Adenovirus and Haemophilus influenzae 3cases each,parainfluenza virus type 3 respiratory syncytial virus,EB virus,streptococcus pneumoniae and pseudomonas aeruginosa 2cases each,Herpes simplex virus,parvovirus19,cytomegalovirus,influenza B virus,Acinetobacter baumannii and Candida albicans 1 cases each.Among them,6 children were infected with 2～8 pathogens.4.Immunologic function: Among 41 children,6 cases(14.6%)had humoral and cellular immune disorders,4 cases(9.8%)had simple cellular immune disorders and 2cases(4.9%)had simple humoral immune disorders.5.Pulmonary imaging: Pulmonary CT examination in 95 children suggested inflammatory changes,Fibrobronchoscope indicates the corresponding pulmonary CT in occluded segment:41 cases with atelectasis or hypo-qi,23 cases with pulmonary consolidation,21 cases with pleural effusion,11 cases with bronchiectasis,Seven patients with bronchiolitis obliterans were characterized by uneven ventilation and mosaic.45 cases(47.4%)children also have the above 2～3 imaging manifestations.6.Bronchoscopy: The occluded site was more common in the lower lobe of the left lung(47.4%),and the number of cases in single and multiple segments was similar.7.Lung function:41 children underwent lung function tests,of whic 38 had different degrees of obstructive ventilation dysfunction,mixed ventilation dysfunction in severe cases.5 cases(13.2%)with severe obstructive ventilation dysfunction,8 cases(21.1%)with moderate obstructive ventilation dysfunction,17 cases(44.7%)with mild obstructive ventilation dysfunction.8 cases(21.1%)of mixed ventilation dysfunction:3cases of severe mixed ventilation dysfunction,3 cases of moderate mixed ventilation dysfunction,2 cases of moderate obstruction with mild restricted ventilation dysfunction.The bronchodiastolic test was negative in 2 cases.3 cases lung function is normal.8.Treatment:All children were given antibiotics,bronchiectasis and symptomatic treatment.Among them,3 cases were treated with auxiliary respiratory support(2 cases without invasive ventilator,1 case with invasive ventilator assisted ventilation).In 30 cases,low-dose glucocorticoid and 15 patients were treated with human immunoglobulin.In 41 cases,lung rehabilitation was guided according to pulmonary function.9.Outcomes and follow-up:The symptoms and signs improvedin 95 children discharged from hospital.15 cases in outpatient follow-up after discharge were re-visited in outpatient clinic,indicating pulmonary CT inflammation absorption and atelectasis,1 case died after re-infection,1 case lobectomy and 1 case transferred to tuberculosis hospital for specialized treatment.Conclusion:1.Bronchitis obliterans in children is more common in older children.2.Mycoplasma pneumoniae infection and adenovirus are the most common pathogen.Affer suffering bronchitis obliterans,mycoplasma pneumoniae,adenovirus and Haemophilus influenzae were eassily secondary.3.Pulmonary CT manifestations are different,mainly atelectasis,consolidation,bronchiectasis,uneven ventilation,mosaic sign.Pulmonary function has different degrees of obstructive ventilation dysfunction,severe mixed ventilation dysfunction.The main criteria for the diagnosis of bronchitis obliterans are bronchoscopy.