Eckel H E, Widemann B, Damm M, Roth B
Department of Oto-Rhino-Laryngology, University of Cologne, Germany.
Int J Pediatr Otorhinolaryngol. 1993 Aug;27(2):147-57. doi: 10.1016/0165-5876(93)90130-u.
Children with bacterial tracheitis present with the symptoms of viral laryngotracheobronchitis or epiglottitis, but do not respond to appropriate therapy for these diseases and frequently develop acute respiratory decompensation. Since the treatment and outcome of bacterial tracheitis differ so much from those of viral laryngotracheobronchitis and epiglottitis, prompt and accurate diagnosis is essential. The aim of this study was to evaluate the significance of different diagnostic characteristics in a group of eleven patients and to compare the results to those recently reported in the pediatric and otorhinolaryngologic literature. The present study suggests that reliable predictive factors do not exist for bacterial tracheitis. No single clinical, radiological or laboratory feature was a reliable diagnostic predictor for bacterial tracheitis, nor was it any combination of these features. The only diagnostic procedure to distinguish bacterial tracheitis accurately and promptly from other forms of acute obstructive upper airway diseases was direct laryngo-tracheo-bronchoscopy. Following endoscopic removal of all tracheal secretions and pulmonary toilet, nasotracheal intubation provides sufficient airway maintenance and obviates the need for tracheostomy. Endoscopy is thus diagnostic and therapeutic at the same time. If bacterial tracheitis is suspected a direct laryngoscopy and rigid tracheobronchoscopy should be performed under general anesthesia, as prompt diagnosis and adequate treatment are essential to survival. The cultures of the purulent tracheal secretions frequently revealed Staphylococcus aureus in combination with various pathogens, particularly the involvement of Pseudomonas aeruginosa was noted in two patients. Our data imply a susceptibility of children with Down's syndrome or immunodeficiency to bacterial tracheitis.
患有细菌性气管炎的儿童表现出病毒性喉气管支气管炎或会厌炎的症状，但对这些疾病的适当治疗无反应，且常出现急性呼吸代偿失调。由于细菌性气管炎的治疗和预后与病毒性喉气管支气管炎和会厌炎差异很大，因此迅速而准确的诊断至关重要。本研究的目的是评估一组11例患者中不同诊断特征的意义，并将结果与儿科和耳鼻咽喉科文献中最近报道的结果进行比较。本研究表明，细菌性气管炎不存在可靠的预测因素。没有单一的临床、放射学或实验室特征是细菌性气管炎的可靠诊断预测指标，这些特征的任何组合也不是。准确而迅速地区分细菌性气管炎与其他形式的急性阻塞性上气道疾病的唯一诊断方法是直接喉镜气管支气管镜检查。在内镜下清除所有气管分泌物并进行肺部灌洗后，鼻气管插管可提供足够的气道维持，无需气管切开术。因此，内镜检查兼具诊断和治疗作用。如果怀疑有细菌性气管炎，应在全身麻醉下进行直接喉镜检查和硬质气管支气管镜检查，因为迅速诊断和适当治疗对生存至关重要。脓性气管分泌物培养经常显示金黄色葡萄球菌与各种病原体混合存在，特别是有两名患者发现了铜绿假单胞菌感染。我们的数据表明，唐氏综合征或免疫缺陷儿童易患细菌性气管炎。
