纤维支气管镜术在PICU呼吸道危重症患儿中的应用

Application of flexible fiberoptic bronchoscopy for the critical patients with severe respiratory diseases in PICU

目的探讨纤维支气管镜术（flexible fiberoptic bronchoscopy, FFB）在诊治PICU呼吸系统危重症患儿气道病变中的应用价值。方法2010年7月至2011年1月本院PICU对189例呼吸系统危重症患儿实施FFB，其中157例（83．06％）患儿的年龄〈3岁。经鼻进镜226次，经气管插管进镜25次。将纤维支气管镜嵌入节段支气管中，向肺段注入生理盐水，进行支气管肺泡灌洗，然后将其吸出，进行病原学诊断。结果189例患儿中，支气管肺泡灌洗液定量培养阳性80例，阳性率42．3％，其中G-杆菌51例，G＋球菌21例，真菌8例。通过FFB诊断气管、支气管异物6例，呼吸道解剖结构异常31例。40例重症肺炎合并呼吸衰竭患儿经FFB肺泡灌洗治疗后，有效35例，无效5例。20例重症肺炎合并肺不张患儿中，16例经灌洗加雾化及全身用药后复张，4例好转。6例气管、支气管异物患儿经FFB全部取出。FFB过程中仅1例出现明显的心动过缓，紧急处理后缓解，无FFB相关的死亡病例。结论PICU中FFB可安全用于呼吸系统危重症患儿，既可行病因诊断，又可行纤维支气管镜下的介入治疗。

Objective To explore the role of flexible fiberoptic bronchoscope（FFB） in the critical patients with severe respiratory diseases of PICU. Methods One hundred and eighty-nine cases of severe respiratory diseases had undergone FFB from Jul 2010 to Jan 2011. One hundred and fifty-seven （83.06%） cases were less than 3 years. FFB examinations were made through nose （226 times） and endotracheal intubation （25 times）. Bronchoscopic lavage for bacterial culture was performed by injecting normal saline solution （NSS） via a syringe into the working channel of FFB. Results Of all 189 cases, bacteria were isolated from 80 cases （42. 3% ） for bacterial culture of bronchoscopic lavage fluid,which included Gbacilli in 51 cases, G ＊ cocci in 21 cases ,and fungi in 8 cases. Six cases with tracheobronchial foreign bodies and 31 cases with respiratory tract anatomical abnormalities were found through FFB. Forty cases of severe pneumonia complicated with respiratory failure underwent bronchoscopic lavage, which were effective in 35 cases, and ineffective in 5 cases. In 20 cases of severe pneumonia atelectasis,pulmonary reexpansion were found in 16 cases by bronchoscopic lavage,atomization inhalation,and systemic administration,4 cases improved. Tracheobronchial foreign bodies were removed in all 6 cases by FFB. During FFB, bradycardia was found in 1 cases. There was no FFB-related death. Conclusion FFB is safe for severe patients with respiratory diseases in PICU. FFB play important role in diagnosis and treatment for children in PICU,including feasible intervention under bronchoscopy.