纤维支气管镜在PICU中的临床应用研究

Role of flexible fiberoptic bronchoscopy in pediatric intensive care unit

目的评估纤维支气管镜（纤支镜）检查及治疗在儿科重症监护中的应用价值。方法回顾性总结我院PICU2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果。结果肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘；其中气道解剖结构异常最为常见，共45例（42．9％）。先天性心脏病（先心病）患儿合并气道解剖结构异常40例（88．9％），明显多于非先心病患儿（P〈0．01）；但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿（P〈0．05）。支气管肺泡灌洗液细菌培养阳性率27．8％，革兰阴性致病菌居多。纤支镜检查有助于气道内出血诊断和气道管理。纤支镜应用过程中，未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生。结论PICU开展纤支镜诊疗安全可靠，具有一定的临床应用价值。

Objective To evaluate the effectiveness of flexible fiberoptic bronchoseopy （FFB）in etiological diagnosis and clinical management of patients of pediatric ICU（PICU）. Methods Our retrospective study was based on medical records in a 25-bed PICU of a teriary care center for children. One hundred and five procedures were performed in 96 patients. Results Airway anatomic anomalies, infection and inflammatory reaction, airway foreign body, polypus, and trachea-oesophagus fistula were the five main causes of segmental lung collapse and pulmonary infections in our hospital. Airway anatomic anomalies were more common in children with congenital heart diseases（CHD） （40 of 47 eases,88.9% ） ,but infection and inflammatory airway changes were more frequently found in children without CHD. FFB had a special role in diognosis and treatment of pulmonary atelectasis, hemoptysis and airway management. A total of 25 strains were isolated from 90 cases, in which the Gram-negative bacteria were the main pathogen. Conclusion FFB is useful and safe in etiological diagnosis and clinical management of very sick infants and children with a variety of respiratory diseases.