纤维支气管镜术诊治小儿呼吸道疾病作用及安全性分析

Study on safety of diagnosis and treatment by flexible fiberoptic bronchoscope in pediatric patients with respiratory diseases

目的探讨纤维支气管镜(纤支镜)术在小儿呼吸道疾病诊治中的价值和安全性。方法回顾性分析贵阳儿童医院呼吸科2004年8月至2011年3月期间,对病因不明或疗效不佳肺不张、反复喘息和慢性咳嗽及咯血等小儿呼吸系统疾病567例,应用纤支镜进行检查及治疗,通过镜下直视、支气管肺泡灌洗、支气管黏膜刷检、组织活检明确病因,肺泡灌洗及注药进行局部治疗,并评判其疗效和并发症发生情况。结果 567例患儿共进行纤支镜诊治术593例次,镜下表现最多的为支气管内膜炎,其次为气管-支气管异物和先天性支气管-肺-血管发育畸形。引起197例肺不张患儿的病因主要为气道炎症或肿胀阻塞115例(58.4%),其次为气道异物73例(37.1%)及支气管内膜结核和(或)干酪样改变3例(1.5%)。115例炎性肺不张经过支气管肺泡灌洗治疗2周79例(68.7%)肺大部分或全部复张,1月105例(91.3%)肺大部分或全部复张。在164例反复喘息/慢性咳嗽病例中气道炎症及黏液栓形成73例(44.5%),其次支气管异物34例(20.7%),先天性心肺发育畸形25例(15.2%)及支气管内膜结核7例(4.4%)。119例发现支气管异物,其中98例(82.4%)用纤支镜取出。气管黏膜刷检涂片找到革兰阳性和(或)阴性细菌127例(127/26448.1%),肺泡灌洗液细菌培养阳性59例(59/30219.5%)。593例次行纤支镜术的患儿中共有151例/次(25.5%)出现术中或术后并发症,均为一过性。大多并发症轻微、短暂。经相应对症处理后各不良反应均消失,无心跳、呼吸骤停及麻醉过敏等影响预后的严重并发症。结论纤支镜术是儿童肺部疾病鉴别诊断和治疗的重要手段之一,可为临床诊断及治疗提供可靠依据。虽然可有轻微并发症,但总体安全可靠。

Objective To explore the diagnostic and therapeutic value and the safety of fiberoptic bronchoscope in the children with respiratory diseases. Methods Clinical data form 567 pediatric patients with respiratory diseases,including atelectasis of unknown origin, recurrent or prolonged wheezing, chronic cough and hemoptysis,were retrospectively analyzed form August 2004 to March 2011. Under local anesthesia, fiberoptic bronchoscope was used with the methods of straight inspection,bronchoalveolar lavage fluid examination and biopsy and bronchus brush examination to identify the pathogeny and to perform therapy with bronchoalveolar lavage and injecting medicine. Results In 567 patients, fiberoptic bronchoscopy was performed 593 times. Under fiberoptic bronchoscope, endotracheitis was the most common, followed by airway foreign body and airway or blood vessel congenital malformation. In 197 patients with atelectasis of unknown origin, inflammation was found in 115 patients（58.4%）, followed by airway foreign body（37.1%） and endobronchial tuberculosis （3.4%）.After bronchoalveolar lavage and administration of drugs,68.7%（79/115）patients with atelectasis were cured in two weeks and 91.3%（79/115）patients were cured in one month. In 164 patients with recurrent wheezing or chronic cough,inflammation was found in 73 patients（44.5%）,followed by airway foreign body in 34 patients（20.7%）,airway or blood vessel congenital malformation in 25 patients（15.2%） and endobronchial tuberculosis in 7 patients（4.4%）.In 119 patients with airway foreign body, foreign body was removed in 98 patients by fiberoptic bronchoscope （82.4%）. The positive rate of bronchoalveolar lavage was 19.5% and gram - positive or gram - negative bacteria in 127 cases （127/264 48.1%）. Some transient and mild complications were observed in 151 times during and 24 hours after fiberoptic bronchoscopy. Meanwhile,most of complications were slight and transient. All adverse reactions disappeared after symptomatic therapy. There was no case of severe complications,such as sudden cessation of respiration and heart beat or anesthesia hypersensititivity. Conclusion The fiberoptic bronchoscope examine is one of the important methods in differential diagnosis and trestment of respiratory diseases ,providing proof for clinical diagnosis and therapy in children. Pediatric fiberoptic bronchoscopy is relatively safe and reliable in spite of its mild complications.