摘要目的 提高对新型甲型H1N1流感(简称甲型流感)合并塑型性支气管炎病理特点、临床特征、诊断、治疗的认识.方法 报道2010年1月厦门大学附属中山医院中心ICU收治的1例甲型流感合并塑型性支气管炎病例并进行相关文献复习.结果 患儿男,5岁,日籍华裔,咳嗽2 d加剧伴气喘,发热1 d,X线胸片示左肺不张、气胸,支气管镜检查吸出条索状异物,病理结果显示为塑型性支气管炎Ⅰ型,咽拭子甲型流感核酸检测阳性,经抗病毒、小量糖皮质激素、抗感染等综合治疗,患儿16 d后痊愈出院.结论 甲型流感合并塑型性支气管炎为一种罕见危重病,病死率高,诊断主要依靠支气管镜检后的病理组织学检查和咽拭子甲型流感核酸阳性检测结果,且早期气管镜取出内生性异物进行诊断和治疗可获得良好的治疗效果,甲型流感亦可能是塑型性支气管炎病因之一.

abstractsObjective To improve understanding of the pathological and clinical features,diagnosis and treatment of plastic bronchitis associate with influenza A ( H1N1 ).Methods One case of plastic bronchitis associated with influenza A ( H1N1 ) diagnosed and treated in our hospital in January 2010 was reported and 19 cases of plastic bronchitis reported in the literature were reviewed.Results We describe a 5-year-old Chinese Japanese boy presenting with cough for 2 days,gasping and fever for 1 day was admitted.Left lung atelectasis and pneumothorax were found on chest X-ray examination.Pathologically,plastic bronchitis was diagnosed after the endogenous foreign body was extracted by bronchoscopy and classified as type 1 cast.In addition,influenza A (H1N1) was confirmed by the swabs which showed positive for H1N1 nucleic acid.The condition was controlled and the patient was cured and discharged after 16-days' treatment with antiviral therapy,low-dose corticosteroids,and antibiotics.Conclusion Plastic bronchitis associated with influenza A (H1N1) is a rare life-threatening disorder.The diagnosis could be made based on pathological findings of the bronchial casts as well as the positive H1N1 nucleic acid detection.Bronchoscopic extraction of casts in plastic bronchitis is not only useful for early diagnosis but an effective therapeutic modality for the disease.Influenza A( H1N1 ) may be a cause of plastic bronchitis.