纤维支气管镜和支气管肺泡灌洗术在儿童难治性肺炎诊治中的应用

Application of fiberoptie bronchoscopy and broncho alveolar lavage in diagnosis and treatment of refractory pneumonia in children

目的探讨纤维支气管镜和支气管肺泡灌洗术在儿童难治性肺炎诊治中的作用。方法对病程3周以上疗效不佳,或病程在1周以内但X线胸片或胸部CT有明显实变或不张经常规治疗1周症状、体征、X线胸片无明显改善的为难治性肺炎80例患儿进行纤维支气管镜检查和支气管肺泡灌洗,并与同期住院的不愿接受纤维支气管镜检查的难治性肺炎30例进行对照观察。结果80例难治性肺炎患儿纤维支气管镜检均显示支气管内膜感染,其中55例同时存在呼吸道的其他疾病。单纯支气管内膜感染25例(31.3%),气管支气管发育异常28例(35.0%),气管支气管异物14例(17.5%),会厌畸形6例,副鼻窦炎6例,右主支气管肿物1例。灌洗组显效76例,有效4例,总有效率100%;对照组显效14例,有效8例,无效8例,总有效率73.3%。两组经统计学处理,灌洗组明显优于对照组(P<0.0001)。结论纤维支气管镜检查和支气管肺泡灌洗术是儿童难治性肺炎病因诊断和治疗的一种非常有效的措施。

Objecitve To study the use of fiber bronchoscopy examination and broncho alveolar lavage in diagnosis and treat- ment of refractory pneumonia in children.Methods 80 children with refractory pneumonia whose course of disease was over 3 weeks and had unsatisfactory results after treatment or course of disease was under 1 week whose chest X-ray or CT had obviously lung consolidation or pulmonary atelectasis or had unsatisfactory results after one-week routine treatment were examined by fiber bronchoscopy and given broncho alveolar lavage.Controlled observation was undertaken in those 80 children and 30 children with refractory pneumonia who refused the fiber bronchoscopy examination.Results Fiber bronehoseopy examination in 80 children with refractory pneumonia all showed bronchial endometrium infection, including 55 cases aceompanyed with other respiratory diseases. Among them, simple bronchial endometrium infection, tracheobronchial abnormal development,tracheobronchial foreign body, epiglottis malformation, accessory sinusitis, right main bronchial mass were 25 cases（31.3%）, 28 cases（35.0%）, 14 eases （17.5%）, 6 eases, 6 eases, 1 ease respectively. 80 cases healed completely well in lavage group, 76 cases had marked effect,4 cases had effect,and the total cure rate was 100%.22 cases healed completely well in control group, 14 eases had marked effect, 8 cases had effect, 8 eases without ef- fect,and the total cure rate was 73.3%. The effective rate of lavage group was better than that of the control group,the difference had statistical significance （P〈0.001）.Conelusion Fiber bronchoscopy examination and broncho alveolar lavage were useful measures for etiological diagnosis and treatment of refractory pneumonia in children.