What are the manifestations of children's bronchitis after it is discovered? How to treat it?

Bronchitis in children refers to bronchial inflammation. The pathological changes of bronchiolitis in children mainly occur in the bronchioles of the lungs, that is, bronchioles. Therefore, the disease is called "bronchiolitis", which is usually a complication caused by viral infections such as the common cold and flu, and may also be caused by bacterial infections. It is a common acute upper respiratory infection in children. Children's bronchitis is called bronchiolitis. The main pathogen of bronchiolitis is respiratory syncytial virus, which can account for more than 80%. Others include adenovirus, parainfluenza virus, rhinovirus and influenza virus. A few cases can be caused by mycoplasma pneumoniae. After being infected by the virus, the tiny bronchioles are congested, edema and mucus secretion increase, and the necrotic mucosal epithelial cells fall off and block the lumen, leading to obvious emphysema and atelectasis. Inflammation can usually involve alveoli, alveolar walls and interstitial lung, so it can be considered as a special type of pneumonia.

Capillary bronchitis, different from ordinary bronchitis or bronchitis, has similar clinical symptoms to pneumonia, but it mainly occurs in children under 2.5 years old, 1 year old accounts for 80%, and children under 6 months are mostly. Typical bronchiolitis often occurs 2-3 days after upper respiratory tract infection, accompanied by persistent dry cough and fever. Body temperature is characterized by moderate to low fever and wheezing. On the 2nd and 3rd day after wheezing, the patient was seriously ill, and his breathing was obviously accelerated during wheezing attack, reaching more than 60-80 times per minute, accompanied by prolonged breathing and wheezing. Severe children are obviously characterized by nasal congestion and "three concave signs" (that is, supraclavicular fossa, suprasternal fossa and upper abdomen depression when inhaling), pale face, blue mouth, or cyanosis, and children are often agitated and groaning; Children with severe illness may be complicated with heart failure or respiratory failure, and most cases can be relieved after treatment, with fewer deaths.

Children should be sent to hospital for treatment in time after onset. Because bronchiolitis is mostly caused by virus infection, antibiotics are generally not needed at the initial stage of the disease. If secondary bacterial infection is suspected in the later stage of the disease, antibiotics can be used for treatment, and the treatment is mainly symptomatic treatment, which can be summarized as "calming the heart and relieving cough". In addition, good care is also very important, especially pay attention not to disturb the children, let them rest quietly, and keep a certain humidity indoors. Severe children can cooperate with atomized inhalation, suck sputum in time, keep the respiratory tract unobstructed, and can also be treated with traditional Chinese medicine.

The prognosis of bronchiolitis is mostly good, and the course of disease is usually 5 ~ 9 days. But it should be noted that children who have suffered from bronchiolitis are prone to asthma in the future. Through the national epidemiological survey of childhood asthma and the follow-up of children with bronchiolitis, it is found that 20% ~ 40% of them will develop into childhood asthma in the future. Therefore, we must actively prevent and treat bronchiolitis to reduce the occurrence of asthma.

Capillary bronchitis sometimes causes epidemics. It happened three times in the southern rural areas of China in the 1970s, Yuncheng in Shanxi in the 1980s, Tianjing in Beijing in the 1990s, and was prevalent in the south in the early 1970s, but there was still a lack of understanding of the disease. At that time, the name of the disease was different and the pathogen was unknown. After the Ministry of Health organized nationwide collaborative monitoring and research on the epidemic situation, it was named "epidemic asthmatic pneumonia". In order to determine its pathogen, medical researchers finally successfully isolated the pathogen of epidemic asthmatic pneumonia-respiratory syncytial virus in 1997, and identified the epidemic as a subtype of respiratory syncytial virus, which provided an important basis for making effective vaccines and preventing the epidemic of bronchiolitis in the future.

(a) It is more common in children under 1, especially in infants under 6 months.

(2) It can occur all year round, but it is more common in winter and spring.

(3) Acute onset, symptoms before catching a cold, such as coughing and sneezing. 1 ~ 2 days later, the cough became worse, and paroxysmal dyspnea, dyspnea, pale face, cyanosis of lips and three concave signs appeared. Early signs of lung were mainly wheezing, followed by wet sound. Severe symptoms may be accompanied by congestive heart failure, respiratory failure, hypoxic encephalopathy and water-electrolyte disorder. Generally, the body temperature does not exceed 38.5℃, and the course of disease is 1 ~ 2 weeks.

(4) Most white blood cells are normal or slightly elevated. Blood gas analysis showed hypoxemia, and arterial partial pressure of carbon dioxide decreased or increased. Chest X-ray shows thicker lung texture, enhanced transparency of both lungs or small shadows and atelectasis. If possible, the respiratory secretion virus can be quickly diagnosed to determine the virus type.

Frequent and deep dry cough occurs, and bronchial secretions gradually appear later. Infants and young children do not cough up phlegm, but swallow it through the pharynx. Those with mild symptoms have no obvious symptoms, and those with severe symptoms have a fever of 38 ~ 39℃, occasionally reaching 40℃, and disappear after 2 ~ 3 days. Feeling tired, affecting sleep appetite, and even vomiting, diarrhea, abdominal pain and other digestive tract symptoms. Older children complain of headaches and chest pains. Cough usually lasts 7 ~ 10 days, sometimes lasts 2 ~ 3 weeks, or recurs. If not treated properly, it can cause pneumonia, with normal or slightly low white blood cells, and those with high white blood cells can be secondary to bacterial infection.

Healthy children rarely have complications, but children with malnutrition, low immune function, congenital respiratory malformation, chronic nasopharyngitis and rickets are not only prone to bronchitis, but also prone to pneumonia, otitis media, laryngitis and sinusitis.

cause of a disease

Most of them are infected by viruses and bacteria. According to epidemiological investigation, there are rhinovirus, syncytial virus, influenza virus and rubella virus. Common bacteria are pneumococcus, hemolytic streptococcus, staphylococcus, influenza bacillus, salmonella and diphtheria bacillus. In addition, sudden temperature change, air pollution, anatomical and physiological characteristics of children's respiratory tract, allergic factors, and low immune function are all causes of this disease. [ 1]

Home care

Bronchitis is a common respiratory disease in children, with a high prevalence rate, which can occur all year round, with the peak in winter and spring. When suffering from bronchitis, children often have symptoms such as fever, cough, loss of appetite or vomiting and diarrhea. Young children may also have bronchiolitis such as wheezing and wheezing. Although a small number of children may develop bronchopneumonia, most of them are mild, mainly treated and cared for at home. Parents should give their children medication according to the doctor's advice and take good care of their families:

First, keep warm: temperature changes, especially cold stimulation, can reduce the local resistance of bronchial mucosa and aggravate the condition of bronchitis. Therefore, parents should change clothes for their children in time with the change of temperature, especially when sleeping, cover their children with quilts to keep their body temperature above 36.5℃.

Second, feed more water: children with bronchitis have different degrees of fever, and the evaporation of water is large. Pay attention to feeding children more water. Can be supplemented with sugar water or sugar salt water, or rice soup and egg soup. The diet is mainly semi-liquid, which increases the water in the body and meets the needs of the body.

Third, adequate nutrition: children with bronchitis consume a lot of nutrients, and fever and bacterial toxins affect gastrointestinal function, and digestion and absorption are poor, so nutritional deficiency in children cannot be ignored. In this regard, parents should give their children a small number of meals and give them a light, nutritious, balanced and digestible semi-liquid or liquid diet, such as porridge, cooked noodles, egg custard, fresh vegetables and juice.

Fourth, turn over and pat the back: when the child coughs and expectorates, it means that the secretions in the bronchus increase. In order to promote the smooth discharge of secretions, you can use an atomizing inhaler to help expectorate, 2-3 times a day, 5-20 minutes each time. If it is an infant, in addition to patting the back, you should also help turn over every 1-2 hours to keep the child in a semi-recumbent position, which is conducive to sputum discharge.

Fifth, reduce fever; Children's bronchitis is mostly moderate to low fever. If the body temperature is below 38.5℃, antipyretics are generally not needed, mainly aiming at the cause and solving the problem fundamentally. If the body temperature is high, older children can be physically cooled, that is, wet compress on the head with a cold towel or take a bath with warm water, but this method is not suitable for children, and drugs should be used to cool down if necessary.

Sixth, maintain a good family environment: the child's bedroom should be warm, ventilated and well lit, and there should be a certain humidity in the air to prevent excessive drying. If there are smokers at home, it is best to quit smoking or smoke outdoors to prevent the adverse effects of tobacco hazards on children.

clinical diagnosis

(1) Clinical manifestations

1. At first, I had a fever, a cold, a headache and a dry throat.

2. The main symptoms are cough and expectoration.

(ii) Main types

1. Acute bronchitis begins with a dry cough, and the amount of sputum gradually increases, gradually becoming mucus purulent.

Bronchitis in children

Bronchitis in children

Phlegm.

2. Chronic bronchitis is mainly characterized by persistent cough, which does not heal for many months and gets worse in the morning and evening, especially at night. The amount of sputum is more or less, and the cough is the fastest. Symptoms and signs are mild in summer, and it is easy to have an acute attack in winter, which makes the condition worse. Repeatedly send the author how thin the body is. Can be complicated with atelectasis, emphysema, bronchiectasis and so on.

(3) Physical and chemical detection

1. At the early stage, the breathing sounds became thicker and blisters could be heard on both sides.

2.x-ray examination: no special manifestations can be found in acute cases. Chronic patients may have corresponding chronic inflammatory changes.

differential diagnosis

(a) patients with mild illness must be differentiated from upper respiratory tract infections.

(2) Bronchial foreign body: When there is respiratory obstruction with infection, the symptoms of respiratory tract are similar to acute tracheitis. Pay attention to ask if there is a history of foreign body inhalation in the respiratory tract. The curative effect is not good after treatment, and it will continue to recur. Chest X-ray examination shows obstructive phenomena, such as atelectasis and emphysema.

(3) Tuberculosis of hilar bronchial lymph nodes: According to the contact history of tuberculosis, tuberculin test and chest X-ray examination.

Capillary bronchitis: more common in infants under 6 months, with obvious acute attack.

Bronchitis in children

Bronchitis in children

Sexual dyspnea and dyspnea. The body temperature is not high, the lung rales are not obvious during wheezing, and the fine wet rales can be heard after relief.

(5) Bronchopneumonia: When the symptoms of acute bronchitis are severe, it should be differentiated from bronchopneumonia.

therapeutic method

Control infection

If acute bronchitis is caused by bacterial infection, the following antibacterial drugs can be selected: compound sulfamethoxazole 0.05/kg/ day, penicillin 30-50 thousand U/ mg/ day, intramuscular injection twice, midecamycin and erythromycin 30-50mg/kg/ day, 3-4 times.

If there is no definite bacterial infection or mixed infection, ribavirin 10- 15 mg/kg/ day can be added for intramuscular injection twice, or 5 mg/kg/ day can be atomized and inhaled twice, or interferon A can be tried for intramuscular injection of 200,000 U/ day.

Symptomatic treatment

1. relieving cough and resolving phlegm: If the sputum is sticky and difficult to be sucked out, it can be inhaled by atomization, and 10% ammonium chloride mixture, Bisuping and Xiaoer Li Qiang Tanling (2-4 years old 1-2 tablets, 5-8 years old 2-3 tablets) can be selected. . Frequent dry cough affects sleep and rest, so you can take a small amount of antitussive drugs, such as promethazine and chlorpromazine 0.5- 1mg/kg/ time, 2-3 times a day. Attention should be paid to avoid overdose and too long time, which will affect the physiological activity of cilia and make it difficult to discharge secretions.