小儿支气管镜检查及肺泡灌洗对内生性支气管异物的临床应用

Children's bronchoscopy and bronchoalveolar lavage on endogenic foreign body in bronchus

目的:探讨小儿支气管镜检查及支气管肺泡灌洗(BAL)对内生性支气管异物临床应用的意义。方法:337例X线胸片提示支气管肺炎并伴有一叶或二叶肺气肿和(或)肺不张。其中22例诊断为重症肺炎并发心力衰竭、呼吸衰竭。无异物呛咳史,全部病例首先用抗生素3d无效且呼吸困难加重者,均作支气管镜检及BAL,在行支气管镜检查排除外源性异物的同时随机以生理盐水和阿奇霉素(AZM)进行BAL,其中126例以生理盐水行BAL为对照组,211例以AZM行BAL为AZM组。对照组平均年龄3.0岁,AZM组平均年龄3.1岁。结果:支气管内生性脓栓331例,其中左侧肺126例,右侧178例,双侧27例。性质:黏液脓性栓子305例,奶瓣栓子4例,塑型支气管炎的白色膜状物22例。AZM组中痊愈172例(81.2%),显效39例(18.8%),总有效率100%。对照组痊愈99例(78.6%),显效24例(19.0%),总有效率97.6%。两组经χ2检验差异无统计学意义(P>0.05)。对照组平均住院11d,AZM组平均住院6d,差异有统计学意义(P<0.05)。术中发生气胸2例,经胸腔闭式引流等对症治疗,气胸消失。死亡3例。结论:支气管镜检查及肺泡灌洗对内生性支气管异物具有缩短小儿肺炎病程的作用,特别是因呼吸道梗阻并发心力衰竭、呼吸衰竭的患儿的治疗是有积极意义的。通过支气管镜检及病理组织学检查,明确塑型支气管炎的诊断。

Objective：To investigate the clinical effect of Children＇s bronchoscopy and bronchoalveolar lavage on endogenic foreign body in bronchus. Method： ①Three hundred and thirty-seven cases had bronchoscopy and bronchoalveolar lavage whose chest X-ray diagnoses were bronchopneumonia with one or two lobe emphysema and/or pulmonary atelectasis,in which 22 cases had severe pneumonia with heart failure and respiratory failure. All cases had no history of foreign bodies＇ inhalation and become more dyspnea after a three-day treatment of antibiotics. Three hundreds and thirty one cases of bronchoalveolar lavages were divided into two groups randomly using saline or azythromycin, saline group had 126 cases （aged 0-10 years, mean age, 3 years ）; azithromycin group had 211 cases（aged 0-8 years, mean age, 3.1 years）. Result ：There were 331 cases of endotracheal endogenous purulent emboli, 126 cases in left lung, 178 in right, and 27 cases in both sides. Judging from nature of emboli, 305 cases were mucus, 4 cases were milk valve, 22 cases were white membrane of plastic bronchitis. In azithromycingroup,172 cases （81.2%）were cured,39 cases （18.8%）showed effective, the total effective rate was 100 percent. In saline group, 96 cases were cured, 24 cases showed effective, the total effecti, ve rate was 100 percent. There wasn＇t statistically significant between two groups in total effective rate. The average hospitalization time had a statistical signifcance between saline group （11 days） and azithromycin group （6 days）. Two cases of complication of pneumothorax happened in operation. They recovered through closed drainage of thoracic cavity and 3 cases dead. Conelusion：Bronchoscopy and bronchoalveolar lavage could shorten the course of endogenic foreign body in bronchus; especially it has significance to those cases of respiratory path obstruction with heart and respiratoy failure. Plastic bronchitis could be determined by bronchoscopy and a pathologic histologic examination thereafter.