支气管镜下肺泡灌洗治疗液体和粉末状异物吸入意外21例

Application of bronchoalveolar lavage treatment via bronchoscopy in the management of accidental inhalation of liquid and powdery foreign bodies in children

目的 探讨支气管镜下肺泡灌洗在儿童液体及粉末状异物吸入意外事故诊疗中的应用.方法 21例患儿,按误吸的种类分为：①油脂类3例；②化学溶剂类2例；③水溶性类15例；④粉状类1例.发生意外3d内住院的患儿有18例（其中有16例在1d内就诊）,发生意外3d以后就诊的有3例.对入院患儿立即给予支气管镜下直接吸引清除和肺泡灌洗清除,以尽快清除吸入的异物,通畅气道,减少吸入物继续吸收和对气道黏膜的局部刺激,防止感染.依据患儿气管镜下所见、临床表现、实验室检查和胸部影像改变,评价疗效、决定是否再次气管镜下治疗和判断预后.结果 21例有不同程度呼吸困难,支气管镜下可见黏膜皆充血、水肿及分泌物附着.灌洗液多呈洗肉水样并明显混有大量吸入物.经2～5次治疗后,18例（86％）痊愈.3例（溺油井、吸入蚊香液、溺粪各1例）或因气道堵塞严重、灌洗困难,病情进行性加重,或因病后3d就诊而贻误病机,或合并真菌感染、气胸最终呼吸衰竭死亡.结论 在儿童液体和粉末状异物吸入意外事故处理中,尽早、多次采用支气管镜下肺泡灌洗是必要和安全有效的诊断治疗方法,吸入物种类、就诊时间、合并感染影响疗效.

Objective To evaluate the effect of bronchoalveolar lavage （BAL） through bronchoscopy in diagnosis and treatment of accidental inhalation of liquid and powdery foreign bodies in children.Method Twenty-one cases of accidental inhalation were classified into the following 4 groups according to the materials inhaled：3 cases inhaled the lipidic material; 2 cases inhaled chemical material;15 cases inhaled hydrosoluble materials; 1 case inhaled powdery material.Eighteen cases were hospitalized within 3 days after the accidents,which included 16 cases treated within 1 day in hospital.And 3 cases were hospitalized 3 days after the accident.After hospitalization,all patients were immediately treated with direct aspiration and lavage clearance method through bronchoscopy.The inhaled foreign materials were cleared as soon as possible,which reduced the absorption,stimulation and infection of respiratory mucosa.The therapeutic effect was evaluated by endoscopic findings,clinical manifestation,laboratory examination and chest imaging.At the same time,decision was made on the second BAL and the prognosis was estimated.Result Twenty-one cases had dyspnea of certain degree.The bronchial mucous membrane of all the 21cases showed hyperemia,edema and exudate attached.Lavage fluid looked like broth and contained much of the inhaled material.After two to five times treatment,18 cases were cured （ 86% ）,but 3 cases died （ 14% ）.One of these 3 cases fell into an oil well,1 into mosquito repellent solution,another into manure pit.The patients who could not survive had severe airway obstruction,which was difficult to clean and made the problem deteriorated progressively.One of the patients was sent to a hospital 3 days after the accident and another case developed fungal infection,pneumothorax and finally respiratory failure.Conclusion BAL through bronchoscopy is necessary for children who accidentally inhaled liquid and powdery materials.This treatment is safe and effective in diagnosis and treatment of such problems in children.The effect of treatment is influenced by types of inhaled material,the time of lavagee clearance through bronchoscopy,and certain complications,such as infection etc.