頁籤選單縮合
題名 | 細菌性氣管炎--四例報告=Bacterial Tracheitis--Report of Four Cases |
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作者 | 黃澤人; 劉清泉; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷期 | 34:4 民88.07-08 |
頁次 | 頁337-342 |
分類號 | 417.5335 |
關鍵詞 | 細菌性氣管炎; Bacterial tracheitis; |
語文 | 中文(Chinese) |
中文摘要 | 細菌性氣管炎為罕見之小兒急性呼吸道感染性疾病,會引起嚴重之上呼吸道阻塞 ,導致呼吸衰竭,在診斷與治療上都需耳鼻喉科醫師之積極參與。國內僅有極少之病例報告 。自 1996 年 5 月至 1998 年 10 月間,我們蒐集 4 例被診斷為細菌性氣管炎之病例,並 詳細審閱其病歷。就病例之性別、年齡、發病年月、臨床症狀、理學檢查、放射影像檢查、 內視鏡檢查、實驗室檢查、治療方法、住院日數及預後情形等加以分析。4 個病例中,男性 3 例,女性 1 例,年齡分佈在 7 個月至 2 歲 3 個月。所有病例都出現發燒、聲嘶、吠咳 、喘鳴、胸骨上內陷及肋骨下內陷之症狀。 並皆瀕臨呼吸衰謁。 2 例之胸部及頸部側面 x 光檢查可見聲門下氣道陰影有變窄之現象。 所有病例都有白血球增多且向左方偏移, 以及 C- 反應性蛋白升高的現象。氣管內分泌物之細菌培養為草緣色鏈球菌 2 例、肺炎鏈球菌及 b 型流行性感冒嗜血桿菌各 1 例。 病毒培養發現 1 例有 B 型流行性感冒病毒之感染。靜 脈注射抗生素療程自 5 日至 12 日。1 例需接受硬式氣管鏡治療。平均住院日為 8 日。所 有病例都沒有發生併發症。小兒之急性感染性上呼吸道阻塞如果以病毒性味吼之治療模式治 療無效時,應立即施行內視鏡檢查以找出引起呼吸道阻塞的病因。細菌性氣管炎在施行內內 視鏡檢查時,於聲門下區及氣管上部可以發現典型的變化:而更可經由氣管內分泌物之細菌 培養而確定診斷。細菌性氣管炎是一種有致命危險性之疾病,即使細菌培養還沒有結果以前 ,也應積極地建立通暢之呼吸道以及給予抗生素治療,以避免嚴重併發症以及死亡之發生。 |
英文摘要 | Bacteria tracheitis is a rare acute infectious disease in children. It frequently causes severe upper airway obsturction and requires the active participation of otolaryngologists in diagnosis and management, There have been very few cases of bacterial tracheitis reported in Taiwan. This articie presents our experience with this disease. The records of the children diagnosed as having bacterial tracheitis between May 1996 and October 1998 were reviewed. Assessment includ demographic characteristics and clinical manifestations, findings on physical, rediological, endoscopic, and laboratory examinations, methods of treatment and outcome. The 4 cases included three boys and one girl. Their ages ranged from 7 months to 2 years and 3 months. All the children had presented with fever, hoarseness, barking cough, stridor, retraction, and impendign respiratory fallure. Subglotic narrowing was demonstrated radiologically in two cases. Leukocytosis with a shift to the left and elevated C-reactive protein were noted in all cases. Bacterial culture of the tracheal secretions yielded virdans streptococci (2 cases), Streptococcus pneumoniae (1 case), annd Haemophilus influenzae type b (1 case). Influenza B infection coexisted in one case. Intravenous antibiotics were given for 5 to 12 days. One patient required bronchoscopic therapy. The average duration of hospitalization was 8 days. All the children were free of complications. In conclusion, young children with symptoms of acute infectious upper airway obstruction, that fail to respond to conventional therapy for viral croup, require immediate endoscopic evaluation to establish the cause of respiratory obstruction. Bactebe rial tracheitis has a characteristic endoscopic picture and its diagnosis can be further verified by bacterial culture of the tracheal secretions. It is a life-threatening disease that requires aggressive airway management and antibiotic therapy, even before the results of bacterial culture, to prevent significant morbidity and mortality |
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