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摘要:目的 探讨塑型性支气管炎（plastic bronchitis, PB）患儿的临床特征及PB患儿中需要呼吸支持的危险因素，提高对PB的识别能力。方法 收集2014年3月–2019年12月在我院确诊为PB的患儿资料并分析其临床特征，根据是否接受呼吸支持分为呼吸支持（respiratory support, RS）组和非呼吸支持（no respiratory support, NRS）组，采用logistic回归分析儿童PB需要呼吸支持的危险因素。结果 本研究共纳入86例PB患儿，其中3岁以上儿童62例（72.1%）；57例（66.3%）患儿有并发症；56例患儿入院后予呼吸支持；86例患儿均有发热、咳嗽，76例（88.4%）体温峰值≥39.5°C；82例（95.3%）存在肺大片实变或不张，63例（73.3%）存在胸腔积液；70例（81.4%）检测出病原体，肺炎支原体感染的阳性率最高（68.6%）。NRS组30例（34.9%），RS组56例（65.1%）。logistic回归分析显示，患儿年龄小于3岁（OR=4.99）、有并发症（OR=7.22）为本组PB患儿需要呼吸支持的独立危险因素（P均<0.05）。结论 临床症状重、合并其他系统并发症、有肺大片实变或不张、胸腔积液以及肺炎支原体阳性时需警惕PB可能。年龄小、合并并发症为PB患儿需要呼吸支持的独立危险因素。Abstract:Objective To investigate the clinical features of pediatric patients who had plastic bronchitis (PB) and to explore the risk factors for respiratory support in the pediatric patients with PB in order to improve the ability to identify PB in children.Methods The basic information and clinical manifestations of 86 children diagnosed with PB at West China Second University Hospital of Sichuan University from March 2014 to December 2019 were collected and analyzed retrospectively. The patients were divided into the respiratory support (RS) group and non-respiratory support (NRS) group as per their need for respiratory support. Logistic regression was conducted to analyze the risk factors for respiratory support in PB patients.Results A total of 86 children with PB were included in the study, including 62 (72.1%) who were over 3 years old. 57 patients (66.3%) had complications. 56 patients were given respiratory support after admission. All the 86 children had a history of fever and cough, and 76 (88.4%) experienced fever peaks≥39.5°C. Chest imaging showed large lung consolidation or atelectasis in 82 cases (95.3%) and pleural effusion in 63 cases (73.3%). 70 cases (81.4%) were tested positive for pathogens, with the highest infection rate of 68.6% for mycoplasma pneumoniae. There were 30 patients (34.9%) in the NRS group and 56 patients (65.1%) in the RS group. Logistic regression analysis showed that patient being younger than 3 years old (OR=4.99) and having complications (OR=7.22) were independent risk factors for respiratory support in children with PB (all P<0.05).Conclusions Clinically, severe clinical symptoms combined with other systemic complications, large lung consolidation or atelectasis, pleural effusion, and positive lab results for mycoplasma pneumoniae should be an alert indicating the possibility of having PB. Young age and complications were independent risk factors for respiratory support in PB patients.
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Keywords:
- Plastic bronchitis /
- Respiratory support /
- Children /
- Bronchoscopy
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表 1 两组PB患儿临床资料
Table 1 Clinical data of the two groups of PB children
Clinical data Respiratory support χ2/Z P Not used
(n=30)Use
(n=56)Sex/case (%) 2.381 0.123 Male 13 (27.7) 34 (72.3) Female 17 (43.6) 22 (56.4) Age/case (%) 4.864 0.027 >3 yr. 4 (16.7) 20 (83.3) ≥3 yr. 26 (41.9) 36 (58.1) Complications/case (%) 12 (21.1) 45 (78.9) 14.236 0.000 Disease duration before admission/d, M (P25, P75) 11
(7.5, 15.0)10
(7.0, 15.0)−0.354
0.723
Length of hospitalization/d, M (P25, P75) 11
(10.0, 13.5)17
(13.0, 20.5)−4.797
0.000
Glucocorticoid use/case
(%)13 (22.4)
45 (77.6)
12.195
0.000
Anhelation/case (%) 6 (15.4) 33 (84.6) 11.945 0.001 Dyspnea/case (%) 0 (0.0) 27 (100.0) 21.084 0.000 WBC/case (%) 8.051 0.018 (4−10)×109 L−1 20 (48.8) 21 (51.2) <4×109 L−1 1 (8.3) 11 (91.7) >10×109 L−1 9 (27.3) 24 (72.7) NEUT/case (%) 4.725 0.030 ≥1.5×109 L−1 30 (38.5) 48 (61.5) <1.5×109 L−1 0 (0.0) 8 (100.0) PLT/case (%) 5.782 0.056 (100−300)×109 L−1 11 (52.4) 10 (47.6) <100×109 L−1 0 (0.0) 5 (100.0) >300×109 L−1 19 (31.7) 41 (68.3) CRP/(mg/L), M (P25, P75)
44
(32.3, 75.9)58
(22.3, 116.9)−0.617
0.537
CRP/case (%) 2.542 0.111 ≤80 mg/L 26 (39.4) 40 (60.6) >80 mg/L 4 (20.0) 16 (80.0) LDH/(U/L), M (P25, P75)
585
(429.0, 1169.0)1262
(624.0, 1748.5)−2.936
0.030
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表 2 是否使用呼吸支持影响因素二元logistic回归结果表
Table 2 Binary logistic regression results of factors affecting the use of respiratory support
Factors B SE Wald P OR 95%CI Age (<3 yr.) 1.607 0.741 4.702 0.030 4.990 1.167-21.336 Complications (yes) 1.977 0.615 10.317 0.001 7.220 2.161-24.124 LDH 0.001 0.001 3.316 0.069 1.001 1.000-1.002 WBC (<4×109 L−1)* 2.113 1.254 2.841 0.092 8.276 0.709-96.606 WBC (>10×109 L−1)* 1.065 0.641 0.190 2.901 0.825-10.198 * Take WBC (4-10)×109 L−1 as a reference；B: Partial regression coefficient; CI: Confidence interval; OR: Odds ratio; SE: Standard error.
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