Necrotizing tracheobronchitis: A newly recognized cause of acute obstruction in mechanically ventilated neonates
Necrotizing tracheobronchitis: A newly recognized cause of acute obstruction in mechanically ventilated neonates
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坏死性气管支气管炎：机械通气新生儿急性阻塞的新发现原因
DOI：
10.1288/00005537-198709000-00003
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
S. Boros
中科院分区：
文献类型：
--
作者：
Kent S. Wilson;R. Carley;M. Mammel;J. Ophoven;S. Boros
坏死性气管支气管炎（NTB）是下呼吸道的急性炎症性病变，可导致完全气道阻塞。虽然可能是可治疗的，但这种病变主要在尸检或动物研究中描述。我们观察到的临床症状反映了这种病变的发展。8例接受高频喷射通气治疗的新生儿出现急性气道阻塞症状（高碳酸血症、呼吸性酸中毒、胸壁运动减少）; 5例接受HFJV治疗的患者无阻塞体征。在重症监护室使用硬质支气管镜进行紧急支气管镜检查。NTB的诊断是通过观察充血、管腔内碎片或焦痂形成的外观来进行的。必要时使用镊子和/或抽吸器清除坏死碎片。所有患者均存活治疗。7例为长期存活者，均患有支气管肺发育不良。在死亡患者中，气道尸检评估显示了由坏死、中性粒细胞浸润、上皮侵蚀和腔内阻塞组成的特征性图像。
Necrotizing tracheobronchitis (NTB) is an acute inflammatory lesion of the lower airway which can result in total airway obstruction. While potentially treatable, this lesion has been described predominantly in autopsy or animal studies. We observed clinical symptoms which reflect development of this lesion. Symptoms of acute airway obstruction (hypercarbia, respiratory acidosis, decreased chest wall movement) occurred in eight neonates undergoing treatment with high‐frequency jet ventilation; five patients treated with HFJV were studied without signs of obstruction. Emergency bronchoscopy using a rigid bronchoscope was performed in the intensive care unit. The diagnosis of NTB was made by the observation of hyperemia, intraluminal debris, or the appearance of eschar formation. Necrotic debris was removed using forceps and/or suction as necessary. All patients survived treatment. Seven were long‐term survivors, all with bronchopulmonary dysplasia. In patients who died, autopsy evaluation of the airway revealed a characteristic picture consisting of necrosis, neutrophil infiltration, epithelial erosion, and intraluminal obstruction.