纤维支气管镜术在小儿慢性咳嗽诊断及治疗中的价值

Value of Fiberoptic Bronchoscopy in Diagnosis and Therapy of Chronic Cough in Children

目的探讨纤维支气管镜(纤支镜)术在小儿慢性咳嗽诊断及治疗中的价值。方法对2006年8月-2011年3月在本院应用纤支镜进行检查和(或)治疗的61例慢性咳嗽患儿的临床资料进行回顾性分析。病例均采用局部麻醉的方法,而且患儿均经临床程序排除咳嗽变异性哮喘和胃食管反流。通过镜下直视、支气管刷检及肺泡灌洗液,明确病因诊断;应用支气管肺泡灌洗、局部注药和钳取异物进行治疗,并对疗效做出评价。结果 61例患儿中男36例,女25例;年龄8个月～13岁。61例患儿镜下炎性改变21例(34.5%),先天性心肺发育畸形12例(19.7%),支气管异物10例(16.4%),上呼吸道咳嗽综合征8例(13.1%),支气管内膜结核7例(11.5%),未见异常3例(4.9%)。气管黏膜刷检涂片找到革兰阳性细菌和(或)革兰阴性细菌12例(12/31例,38.7%),肺泡灌洗液细菌培养阳性5例(5/40例,12.5%),未找到抗酸杆菌和癌细胞。对镜下炎性改变重、有痰栓阻塞者经纤支镜行支气管灌洗治疗,取得较好疗效。10例支气管异物经纤支镜成功取出8例。结论小儿慢性咳嗽经纤支镜检查发现以炎症及支呼吸管异物多见,婴幼儿期慢性咳嗽应警惕心肺发育异常及呼吸道异物。纤支镜检查对儿童慢性咳嗽的病因诊断与治疗具有重要价值,尤其对先天性心肺发育畸形及支气管细小异物的诊断有独特价值。

Objective To explore the value of fiberoptic bronchoscopy in diagnosis and therapy of chronic cough in children. Methods Clinical data of 61 patients with chronic cough in Department of Respiration, Guiyang Children＇s Hospital,were retrospectively analyzed from Aug. 2006 to Mar. 2011. Under local anesthesia,fiberoptic bronchoseopy was performed in those patients. The straight inspection, bronchus brush biopsy and analysis of alveolus lavage fluid were performed to identify the pathogeny, and bronchoalveolar lavement,injecting medicine and extracting bronchial foreign bodies were used, the entire efficacy was evaluated. All patients were denied the diagnosis of cough variant asthma and gastroesophageal reflux. Results In 61 cases,36 cases were male and 25 cases were female. The ages were from 8 months to 13 years old. Through fiberoptic bronchoscopy, there were 21 cases （ 34.5% ） with inflammation, 12 cases （ 19.7% ） with airway congenital malformation, 10 cases （16.4%）with bronchial foreign bodies ,8 cases （13.1% ）with upper airways cough syndrome ,7 cases （11.5% ）with endobronehial tuberculosis,and 3 cases （4.9%） were normal. The positive rate of bronchoalveolar lavage was 12.5% and there was gram - positive or gram - negative bacteria in 12 cases （ 12/31 cases,38.7% ）. Optimal effect was acquired after bronchoalveolar lavage and administration of drug. Among the 10 patients with airway foreign body ,8 patients had their foreign bodies removed through fiberoptic bronehoscope. Conclusions Inflammation, airway congenital malformation and bronchial foreign bodies are main reasons for chronic cough in children. Fiberoptic bronchoseopy is useful in the etiologic identification of chronic cough in children and it has featured value in diagnosis for airway congenital malformation and tiny foreign body.