课件-儿童闭塞性细支气管炎ppt课件.ppt

CT改变 例数（N） 构成比 马赛克灌注 空气滞留 支气管壁增厚 支气管扩张 肺不张 支气管黏液栓 220 230 195 240 165 145 88 92 78 96 66 58 250例儿童及青少年CT改变 Diagnosis Although a diagnosis of PIBO should be confirmed by histopathology, most pediatric pulmonologists diagnose PIBO based on history and clinical findings according to the following criteria: (1) acute severe respiratory infection during childhood, especially early childhood; (2) persistent airway obstruction after initial insult and unresponsiveness to systemic steroids and bronchodilators, as demonstrated by clinical symptoms and signs, and a lung function test, if it can be performed; (3) mosaic perfusion, air trapping, and/or bronchiectasis in chest computed tomography; and (4) exclusion of other chronic lung diseases such as severe asthma, bronchopulmonary dysplasia, chronic aspiration, primary ciliary dyskinesia, cystic fibrosis, immunodeficiency, and alpha-1-antitrypsin deficiency (Table 1). Recent studies of clinical prediction rules to diagnose PIBO in children found that typical clinical history, adenovirus infection, and high-resolution computed tomography with mosaic perfusion were highly predictable variables32).  History of lower respiratory infection, particularly adenovirus, mycoplasma, or measles. Persistent airway obstruction symptoms and signs, or recurrent airway obstruction symptoms and signs in a mild form. Sign of obstruction: FEV1/FVC 0.8 or FEV1 percent predicted 80%. Irreversible airway obstruction demonstrated by lung function test: absent BDR, but positive BDR in some patients. CT (inspiration and expiration): mosaic perfusion, air trapping, and/or bronchiectasis. Exclusion of other chronic lung disease (asthma, BPD, chronic aspiration, PCD, cystic fibrosis, and immunodeficiency). Postinfectious bronchiolitis obliterans is clinically diagnosed when all of the above criteria are met. FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; BDR, bronchodilator response; BPD, bronchopulmo