細菌性氣管炎－四例報告

Bacterial Tracheitis - Report of Four Cases

黃澤人(Tzer-Zen Hwang) ； 劉清泉(Ching-Chuan Liu)

《中華民國耳鼻喉科醫學雜誌》 34卷4期 (1999/07) Pp. 337-342

https://doi.org/10.6286/1999.34.4.337

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，並皆瀕臨呼吸衰竭。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綠色鏈球菌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哮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。

關鍵字

細菌性氣管炎

並列摘要

Bacterial tracheitis is a rare acute infectious disease in children. It frequently causes severe upper airway obstruction and requires the active participation of otolaryngologists in diagnosis and management. There have been very few cases of bacterial tracheitis reported in Taiwan. This article presents our experience with this disease. The records of the children diag-nosed as having bacterial tracheitis between May 1996 and October 1998 were reviewed. Assessment includ demographic characteristics and clinical manifestations, findings on physical, radiological, endoscopic, and labora-tory 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 impending respiratory failure. Subglot-tic narrowing was demonstrated radiologically in two cases. Leukocytosis with a shife to the left and elevated C-reactive protein were noted in all cases. Bacterial culture of the tracheal secretions yielded viridans strepto-cocci (2 cases), Streptococcus pneumoniae (1 case), and 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 endo-scopic evaluation to establish the cause of respiratory obstruction. Bacte-rail 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.

並列關鍵字

bacterial tracheitis