小儿纤维支气管镜检查与治疗的安全性探讨

Safety of pediatric fiberoptic bronchoscopy

目的探讨小儿纤维支气管镜(纤支镜)检查与治疗的并发症,及其发生率和影响因素。方法对335例患儿进行纤支镜术中和术后24h并发症进行观察。结果335例行纤支镜术的患儿中共有141例(42.1%)出现术中或术后并发症,均为一过性。0～1岁、～3岁、～7岁和～14岁组并发症的发生率分别为51.5%、41.9%、37.7%和13.0%,后者明显低于其他各组。术中并发症以紫绀最常见,以婴儿组最高,随年龄增大而降低;术后并发症则以咳嗽或咳嗽加重最常见,气喘或气喘加重均发生于婴儿。支气管肺泡灌洗(BAL)患儿术后并发症为15.0%,高于未进行BAL患儿(9.5%),但无统计学差异。喉或气管支气管软化患儿术中或术后并发症50.0%,未软化的患儿28.0%,统计差异显著。结论儿科纤支镜术安全可靠,虽有一定的并发症,但大多轻微。婴儿及喉-气管支气管软化是并发症发生的高危因素。

Objective To observe the complication rates during and after pediatric fiberoptic bronchoscopy （FOB） and its risk factors. Methods Three hundred and thirty-five cases were observed for complications during and 24 hours after FOB. Results Some transient and mild complications were observed in 141 cases （42.1%） during and 24 hours after FOB. The complication rates were 51.5%, 41.9%, 37.7% and 13.0% in children younger than 1 year, ～3 year, ～7 year and～14 year-old, respectively, with much lower rate in eldest group than that of the other groups. Cyanosis was most frequently seen during FOB. The peak rate happened in infancy and decreased with increasing age. The most frequent complication within 24 hours after FOB was cough or exacerbated cough. Wheezing or exacerbated wheezing within 24 hours after FOB only occurred in infancy. Fifteen percent of children with bronchoalveolar lavage （BAL） had complications as compared to 9.5% in children not received BAL, showing no statistical significance. Half of children with laryngeal or tracheal-bronchial malacia had complications as compared with 28.0% in children without malacia, showing statistical significance. Conclusions Pediatric FOB is relatively safe and reliable in spite of its high but mild complications. Young age and laryngeal or tracheal-bronchial malacia are high-risk factors for complications.