Bronchiolitis in children
Introduction
Introduction to Pediatric Bronchiolitis Bronchitis refers to inflammation of the bronchus. The most common and serious form of bronchiolitis in children is that it occurs in winter and can cause local epidemics. The disease of bronchiolitis mainly occurs in the small bronchi of the lungs, that is, the bronchioles. Therefore, the disease is called "bronchiolitis", which is usually a complication caused by a common viral infection such as the common cold or influenza. It may also be caused by bacteria. It is caused by infection and is an acute lower respiratory tract infection common in children. basic knowledge The proportion of illness: 0.025% Susceptible people: children Mode of infection: non-infectious Complications: respiratory failure, brain edema, heart failure, dehydration, metabolic acidosis
Cause
Causes of bronchiolitis in children
Virus infection (45%):
Bronchiolitis can be caused by different viruses. Respiratory syncytial virus (RSV) is the most common pathogen. In the case of the Institute of Pediatrics of the Chinese Academy of Medical Sciences, 58% of the syncytial viruses were isolated. In addition, the parainfluenza virus (3) Type is more common), adenovirus, influenza virus, reovirus and rhinovirus can cause bronchiolitis, a few are caused by human Mycoplasma pneumoniae. In the past, even from this disease, influenza bacilli were isolated, possibly in very rare cases. It is a pathogen, but it may also be a mixed infection with bacteria or viruses and bacteria.
Dust stimulation (25%):
When the temperature drops suddenly, the small blood vessels in the respiratory tract, ischemia, and the decline in defense function are conducive to disease, chronic stimuli such as smoke dust and pollution of the atmosphere may also occur.
Allergies (10%):
Allergic factors also have a certain relationship.
Pathogenesis
The lesion mainly invades the bronchioles with a diameter of 75-300 m, increased mucus secretion, cell destruction, cellulose clogging, epithelial cell necrosis and peri-bronchial lymphocytic infiltration, inflammation can affect alveolar, alveolar wall and interstitial lung, lung not Zhang, emphysema is more obvious.
Prevention
Pediatric bronchiolitis prevention
Reasonable feeding, good hygienic habits, avoiding contact with children such as colds, and not going to public places with poor air circulation are the basic measures to prevent acute bronchiolitis. Winter temperatures are fluctuating. To prevent respiratory diseases, first of all, keep warm. At the same time, the autumn and winter are very dry, the air dust content is high, the human nasal mucosa is easily damaged, drink plenty of water, maintain proper indoor humidity, and properly add vitamins, especially vitamin C. Maintain a good home environment, fresh indoor air circulation, control and eliminate all kinds of harmful gases and smoke. Pay attention to adding clothes in time to avoid catching colds and prevent flu.
Complication
Pediatric bronchiolitis complications Complications, respiratory failure, cerebral edema, heart failure, dehydration, metabolic acidosis
Prone to respiratory failure, cerebral edema, heart failure, etc., dehydration and metabolic acidosis.
Symptom
Pediatric bronchiolitis symptoms Common symptoms Three concave signs, dry sputum, low heat, dry cough, dehydration, wheezing, wet snoring, dyspnea, heart failure
Often 2 to 3 days after the upper respiratory tract infection, persistent dry cough and episodic dyspnea, cough and wheezing occur at the same time as the characteristics of the disease, the symptoms are mild and severe, the severe breathing difficulties develop very fast, the cough is slightly like pertussis, the beginning At the beginning, the respiratory symptoms are far more serious than the symptoms of poisoning, with episodes of wheezing, different body temperature, low fever (even without heat), moderate fever and high fever account for about 1/3, body temperature and general condition are not parallel, generally Although there is vomiting, but not serious, there is no serious diarrhea, due to emphysema and chest expansion and compression of the abdomen, often affecting the milk and diet, breathing is fast and shallow, often accompanied by expiratory wheezing, The respiratory rate is about 60-80 times/min, or even more than 100 times/min. The pulse is fast and thin, often up to 160-200 times/min, and there are obvious nasal fans and three concave signs.
Examine
Pediatric bronchiolitis examination
1, blood
The total number and classification of white blood cells are mostly in the normal range, neutrophils are often below 60%, and eosinophils are normal.
2, blood gas analysis
The blood gas analysis of the heavier infants may have metabolic acidosis. About 1/10 of the cases may have respiratory acidosis. Blood gas examination showed that the blood pH decreased, PaO2 and SaO2 decreased, and PaC02 decreased (over-ventilation). Or increase (CO2 retention).
3, pathogen examination
The rapid diagnosis of the virus is carried out by immunofluorescence technique, enzyme-labeled antibody staining or ELISA, and the conditional unit can perform virus isolation and double serum tests to determine various viral infections, nasopharyngeal swab bacterial culture and healthy children. Significantly different (both can have a carrier).
4, X-ray inspection
It can be seen that there are different degrees of obstructive emphysema in the whole lung. The film can show signs of inflammation around the bronchi, or the lungs are thick and thick. In many cases, the alveoli are also obviously affected, and there are small patches of shadows, but no large deformation. , different from adenovirus pneumonia.
5, ECG
Increased heart rate can have myocardial damage.
6, X-ray chest examination
There are obvious signs of emphysema, and the application of antibiotics is ineffective, so it is easier to distinguish from other acute pneumonia.
Diagnosis
Diagnosis and diagnosis of bronchiolitis in children
diagnosis
Severely ill children have obvious obstructive emphysema, pale and cyanosis, chest signs often have variations, percussive drum sounds, whenever the bronchioles are close to complete obstruction, the breath sounds are significantly reduced, or inaudible, in asthma When you have a sudden attack, you may not hear a wet voice. When the wheezing is relieved, you may have a diffuse wet voice or a wet voice. The wheezing sound is often obvious. Sometimes there is a dry sound such as a beep. The ribs are widened, the ribs are transverse, the diaphragm and the liver are spleen, and the spleen is pushed downward due to emphysema. Due to the increase in inductive water loss and insufficient fluid intake due to excessive ventilation, some children may be more serious. Dehydration, in small babies may also have metabolic acidosis, severe asthma can have carbon dioxide retention, respiratory acidosis, arterial oxygen partial pressure decreased, after correct treatment, development of heart failure is rare The patient is younger, more common in 2 years old, especially in 6 months, the fever is generally not high or normal, in the early stage of the disease can have episodes of dyspnea, wheezing, physical examination of both lungs Wheezing, combined with X-ray The examination can confirm the diagnosis.
Differential diagnosis
The disease sometimes needs to be identified with the following diseases.
Infant asthma
The first infectious wheezing episode in infants, mostly bronchiolitis, if there are repeated wheezing episodes, relatives have a history of allergies, there may be asthma in infants and young children, try adrenaline or aminophylline drugs, asthma It can be effective quickly, but the effect of this disease is not obvious.
2. Asthmatic bronchitis
It is sometimes indistinguishable from mild bronchiolitis, but there is no obvious emphysema in this disease. Therefore, cough and asthma are not heavy, and there is no symptoms of poisoning, and there are repeated episodes in the future.
3. Adenovirus pneumonia
More common in infants and young children 6 to 24 months, high fever, long heat history, obvious symptoms of poisoning, and asthmatic symptoms appear later, pneumonia signs are more obvious, in the chest X-ray examination, more large-scale fusion lesions can be seen .
Miliary tuberculosis
Sometimes it is episodes of wheezing, but it is generally not heard, there are other symptoms of tuberculosis, tuberculin test positive and X-ray findings, are helpful for the diagnosis of tuberculosis.
5. Other diseases
Pertussis, congestive heart failure, endocardial fibroelastosis, zinc stearate (in the powder) inhalation and foreign bodies, can occur wheezing, and sometimes need to be identified.
