Plastic bronchitis in children: A case series and review of the medical literature
Plastic bronchitis in children: A case series and review of the medical literature
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DOI：
10.1002/ppul.10179
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发表时间：
2002-12-01
影响因子：
3.1
通讯作者：
Gibson, RL
中科院分区：
文献类型：
--
作者：
Brogan, TV;Finn, LS;Gibson, RL
可塑性支气管炎的特征是支气管管型明显阻塞大气道。我们回顾了我们的经验和文献，以确定死亡率是否由基础疾病或石膏类型决定。我们报告3例阻塞性支气管管型。一例3岁努南综合征患者在法洛四联症手术后发生呼吸衰竭，需要体外膜肺氧合（ECMO）支持，这是首例此类病例。文献中有42例儿童可塑性支气管炎。铸件可分为两种类型。I型管型是炎症性的，主要由纤维蛋白和细胞浸润组成，发生在肺部炎症性疾病中。II型，或无细胞管型，主要由粘蛋白和少量细胞组成，通常发生在先天性心脏缺陷手术后。按基础疾病分类的患者包括31%的哮喘或过敏性疾病，40%的基础心脏缺陷，29%的其他疾病。死亡率为16%，但在心脏缺陷患者中增加至29%。死亡发生在手术修复潜在缺陷后长达1年。哮喘患者无死亡。心脏缺陷患者的危及生命事件发生率（41%）高于哮喘患者（0%，P = 0.02）。与I型管型相比，II型管型患者的死亡率更高，但未达到统计学显著性（28% vs. 6%; P = 0.06）。总之，表现为可塑性支气管炎的患者发生严重并发症的风险很高，尤其是伴有基础心脏病的患者。(C)2002 Wiley-Liss，Inc.
Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts. We reviewed our experience and the literature to determine whether mortality rates are determined by underlying disease or cast type. We present 3 children with obstructive bronchial casts. One 3-year-old patient with Noonan's syndrome developed respiratory failure following surgery for tetralogy of Fallot requiring support with extracorporeal membrane oxygenation (ECMO) the first such case. There were 42 cases in the literature of children with plastic bronchitis. Casts may be divided into two types. Type I casts are inflammatory, consisting mainly of fibrin with cellular infiltrates, and occur in inflammatory diseases of the lung. Type II, or acellular casts, consist mainly of mucin with a few cells, and usually occur following surgery for congenital cardiac defects. Patients categorized by underlying disease included 31% with asthma or allergic disease, 40% with underlying cardiac defects, and 29% with other diseases. Mortality was 16%, but increased to 29% in patients with cardiac defects. Deaths occurred as long as 1 year after surgical repair for underlying defects. There were no deaths in patients with asthma. Life-threatening events were statistically higher in patients with cardiac defects (41%) than in those with asthma (0%, P = 0.02). Higher mortality in patients with type II casts compared to type I casts did not reach statistical significance (28% vs. 6%; P = 0.06). In conclusion, patients presenting with plastic bronchitis are at high risk for serious complications, especially with underlying cardiac disease. (C) 2002 Wiley-Liss, Inc.