acute tracheobronchitis in children
Introduction
Introduction to acute tracheobronchitis in children Acute bronchitis (acutetracheobronchitis) is an acute inflammation of the bronchial mucosa caused by infection of pathogens such as viruses or bacteria. It is a common and frequently-occurring disease in infants and young children. It is often secondary to upper respiratory tract infections and is often an early manifestation of pneumonia. This disease involves both the trachea and bronchus, so the correct name should be acute tracheobronchitis, clinically characterized by cough with or without bronchial secretion. basic knowledge The proportion of illness: 42% Susceptible people: young children Mode of infection: non-infectious Complications: pneumonia otitis media
Cause
Causes of acute tracheobronchitis in children
Causes:
Mainly infection, the pathogen is a virus, Mycoplasma pneumoniae or bacteria, or it is a combined infection. In the case of viral infection, influenza, adenovirus, type 3 parainfluenza virus and respiratory syncytial virus are the majority, and Mycoplasma pneumoniae is not uncommon. The virus that can cause upper respiratory tract infection can become the pathogen of bronchitis. On the basis of viral infection, pathogenic bacteria can cause secondary infection. The more common bacteria are pneumococci, -hemolytic streptococcus group A, staphylococcus And influenza bacilli, sometimes B. pertussis, Salmonella or diphtheria, environmental pollution, air pollution or frequent exposure to toxic gases can also stimulate inflammation of the bronchial mucosa, immune function or specific qualities such as malnutrition, rickets, allergies and Chronic rhinitis, pharyngitis, etc. can be the cause of this disease.
Pathogenesis:
Pediatric nasal, pharyngeal, tracheal and bronchial stenosis, soft cartilage, lack of elastic tissue, mucous membranes, slender and rich blood vessels, insufficient secretion of mucous glands and dry and other physiological anatomical features and poor immune function, so that childhood Prone to respiratory infections, tracheal and bronchitis, mucosal congestion is an early change, followed by scaling, edema, submucosal leukocyte infiltration, viscous or mucopurulent secretions, bronchial cilia, macrophage and lymphatic defense Dysfunction, bacteria can invade the normal sterile bronchus, and then cell debris and mucus purulent secretions are accumulated. Cough is necessary to exclude bronchial secretions, bronchial wall edema, secretion retention, and bronchial smooth muscle spasm in some patients. Can cause airway obstruction.
Prevention
Prevention of acute tracheobronchitis in children
The disease is often secondary to upper respiratory tract infections, and the prevention method is the same as upper respiratory tract infection.
Active exercise
It is very important to use physical factors to exercise physique. For example, frequent window sleep, outdoor activities and physical exercise are all positive methods. As long as they persist, they can enhance their physical fitness and prevent upper respiratory tract infections.
2. Talking about hygiene
Avoid the cause of the disease too much dressing too much, too high room temperature too low, sudden changes in the weather, environmental pollution and passive smoking, etc., are the cause of upper respiratory tract infection.
3. Avoid cross infection
Wash hands after contact with patients, wear isolation gowns when necessary in general care institutions and hospitals. Isolation not only protects neighboring children, but also reduces complications in sick children. Ventilation should be carried out in the ward to maintain proper temperature and humidity and disinfect patients in time. Beds are packed to prevent the spread of pathogens. In the home, adult patients should avoid contact with healthy children.
4. Drug prevention
Card slow Shu, infant 5ml, children 10ml oral, 3 times / d, 3 ~ 6 months for a course of treatment, levamisole 2.5mg / (kg · d), 2 days a week, 3 months for a course of treatment, Chinese medicine Astragalus sinensis 6 ~ 9g per day, even for 2 to 3 months, the above drugs have the effect of improving the body's cellular and humoral immune function, repeated application of upper respiratory tract infection in children can reduce the number of recurrences, Beijing Friendship Hospital Pediatrics used Chinese medicine to add Yupingfeng San Formula: raw scutellaria 9g, Atractylodes 6g, windproof 3g, raw oyster 9g, dried tangerine peel 6g, yam 9g, research into fine powder) 2 times / d, each time 3g, oral, through 3 years of observation, that this drug seems to improve the body Weak immunity, reducing the incidence of repeated respiratory infections.
5. Vaccination
Recently, the application of attenuated virus vaccine, by intranasal instillation and/or aerosol inhalation, can stimulate the secretion of secretory IgA on the mucosal surface of the nasal cavity and upper respiratory tract, thereby enhancing the defense ability of the respiratory tract to infection. A large number of studies indicate that the secretory type IgA is more effective against respiratory infections than any serum antibody, and because of the type of enterovirus and rhinovirus, it is difficult to prevent it with a vaccine.
Complication
Complications of acute tracheobronchitis in children Complications pneumonia otitis media
Physically healthy children have few complications, but in malnutrition, low immune function, congenital airway malformation, chronic nasopharyngitis, rickets and other diseases, prone to pneumonia, otitis media, laryngitis, sinusitis, etc., such as children with exhalation Prolonged, three-concave signs and other dyspnea manifestations may be asthmatic bronchitis, more than children with allergies, such as children with cyanosis, suggesting that the condition is aggravated, if not treated in time, it is easy to develop pneumonia.
Symptom
Acute tracheobronchial symptoms in children Common symptoms Chest pain, dry cough, double lung vesicle, abdominal pain, nausea, vomiting, fatigue, chill, loss of appetite, diarrhea
Most of the onset of symptoms of upper respiratory tract infection, but also a frequent and deep dry cough, and gradually bronchial secretions, can be heard in the chest, wet voice, with a fixed medium bubble sound, and occasionally limited On one side, infants and young children will not cough, and will swallow in the throat. The symptoms are mild and there is no obvious disease. The severe fever is 38~39°C, occasionally up to 40°C, and more than 2~3 days of fever, feeling tired and affecting sleep. Appetite, even vomiting, diarrhea, abdominal pain and other gastrointestinal symptoms, older children can complain of headache and chest pain, cough generally lasts 7 to 10 days, sometimes 2 to 3 weeks, or repeated episodes, if not treated properly can cause pneumonia Generally, white blood cells are normal or slightly lower, and elevated people may have secondary bacterial infections.
Examine
Examination of acute tracheobronchitis in children
Blood picture
The white blood cells are normal or slightly lower, and the total number of white blood cells and classified neutrophils in secondary bacterial infections can be elevated, and eosinophils are elevated in the white blood cell classification of children with asthmatic bronchitis.
2. Serum antibodies
In children with asthmatic bronchitis, serum IgE levels are elevated, X-ray examination is normal or the lungs are thickened, and children with asthmatic bronchitis may present mild emphysema in both lungs.
Diagnosis
Diagnosis and diagnosis of acute tracheobronchitis in children
diagnosis
According to respiratory symptoms, signs, combined with auxiliary examination can generally be diagnosed.
1. Acute onset: fever can be high or low, mild chills, headache and other systemic symptoms, loss of appetite, vomiting or diarrhea.
2. Cough: dry cough or convulsions.
3. Signs: There is more congestion in the pharynx, the lungs have a loud breath or the lungs are dry, wet, and the nature and location are variable.
4. Blood: In the secondary bacterial infection, the white blood cell count and the neutrophil ratio increase.
5. Chest X-ray examination: normal or see increased lung texture.
Differential diagnosis
Bronchitis is mainly based on cough, snoring, lungs with unfixed dry, wet sputum, etc. Diagnostic asthma bronchitis is mainly based on recurrent episodes and obvious expiratory wheezing, extensive wheezing sounds in the lungs and Diagnosis such as prolonged exhalation should be identified with the following diseases.
Bronchopneumonia
Severe bronchitis and pneumonia are difficult to identify early, but the general respiratory bronchial pneumonia has a significantly increased respiratory rate, 60 beats/min in children under 2 months, 50 beats/min in children 2-12 months, 40 years old 40 Times / min, there are breathing difficulties, the two lungs can be heard fixed small wet voice or sputum pronunciation, especially at the bottom of the lungs, the spine, under the armpit is obvious, no significant reduction in the voice after cough should consider pneumonia, can be used for chest X Line check to confirm the diagnosis.
2. Bronchial asthma
The disease is more common in older children, has a history of recurrent asthma, asthma attacks can be unrelated to infection, can also be induced by infection, generally no fever, often sudden attacks in the morning or night, the application of bronchodilators can quickly relieve.
3. Capillary bronchitis
Mainly caused by respiratory syncytial virus infection, more common within 6 months of small infants, often suddenly onset, respiratory symptoms at the beginning of the disease is far more serious than the symptoms of poisoning, manifested as episodes of wheezing, expiratory breathing difficulties, obvious three concave Signs and hairpins, general body temperature is not high, both lungs smell and obvious wheezing sound, the bottom of the lungs can have a fine wet voice.
4. Bronchial foreign body
In addition, recurrent bronchial inflammation should be differentiated from bronchial foreign body, congenital upper respiratory tract malformation, right middle lobe syndrome, and other diseases such as bronchial foreign body, tumor compression, etc., often repeated coughing, long-term cure, airway foreign body cough And the history of foreign body inhalation, the film see opaque foreign body shadow or atelectasis.
5. Tuberculosis
It should be identified according to the history of vaccination, the history of exposure, and the specific performance of the film.
