纤维支气管镜在新生儿临床应用的安全性分析（附12例报告）

Safety of fiberoptic bronchuscopy in neonate respiratory diseases

目的评价纤维支气管镜（简称纤支镜）在新生儿呼吸系统疾病临床应用的安全性。方法对12例纤支镜检查新生儿进行前瞻性研究，分析新生儿呼吸系统疾病特征，观察纤支镜检查前后生命体征的变化，评价气管内压力支持通气的作用。结果12例新生儿顺利完成纤支镜检查，其中NICU患儿10例（83％）。11例发生并发症，发生率为92％，全部为明显低氧血症及高碳酸血症，其中合并X线胸片肺部阴影扩大3例（25％），呼吸道出血2例（17％），心力衰竭1例（8％）。检查前后脉搏、血压差异无显著性（P〉0．05），而检查后气促症状改善（P〈0．05）。心力衰竭应用西地兰、速尿治疗后纠正，呼吸道出血、肺部阴影扩大无需处理。气管内压力支持通气可保证新生儿纤支镜检查期间正常氧合。结论纤支镜检查在新生儿呼吸系统疾病（包括部分重症新生儿）的临床应用是安全的。

Objective To assess the safety of fiberoptie bronchoscopy （FB） in neonate respiratory diseases. Methods Twelve neonates received FB were studied prospectively, the features of the neonate respiratory diseases were studied, the changes of the neonate vital signs before and after FB were investigated, and the effects of intratracheal pressure support ventilation （PSV） during FB were assessed. Results FB were successfully finished in all 12 neonates, there were 10 neonates of NICU. The total incidence of complication was 92 %, all were hypoxemia and hypercapnia in 11 neonates, in which, with expansion of lung filtration in chest X-ray film in 3 neonates （25 % ）, respiratory tract bleeding in 2 neonates （17 % ）, and congestive heart failure in 1 neonate （8%）. The pulse and blood pressure of the neonates before and after FB did not differ significantly. There was a relief of tachypnea after FB（ P 〈 0.05）. The neonate with congestive heart failure was cured by cedilanid and furosemide, the respiratory tract breeding and expansion of the lung filtration needed not treatment. The neonates with cyanosis could maintain normal oxygenatin by intratracheal PSV. Conclusion FB is safe in neonate respiratory diseases, even in part of NICU patients.