电子支气管镜术在婴幼儿反复喘息性疾病中的诊疗价值

The value of electronic bronchoscopy in diagnosis and treatment of asthmatic disease in infants

目的探讨电子支气管镜术对婴幼儿反复喘息性疾病的诊断以及相关的治疗价值。方法将68例以反复喘息经常规治疗无效的患儿予表面局部麻醉后行电子支气管镜术,通过镜下直视观察及灌洗液病原学检查进一步明确病因,同时进行支气管肺泡灌洗和灌注抗生素等局部治疗,并评判其疗效和并发症发生情况。结果 68例患儿经电子支气管镜检查,镜下明确诊断支气管内膜炎改变32例(47.05%),镜下表现炎症改变重、分泌物黏稠、痰栓阻塞,患儿经电子支气管镜支气管冲洗后,咳喘明显缓解,取得较好疗效。支气管狭窄14例(20.58%),支气管异物11例(16.17%),后经电子支气管镜成功取出4例,其余7例转入我院耳鼻喉科取出,支气管软化症9例(13.23%),支气管内膜结核2例。镜下表现为支气管内膜炎症的32例患儿,支气管肺泡灌洗液病原学检查阳性11例(34.37%),其中肺炎支原体6例,肺炎链球菌和结核杆菌各2例,肺炎克雷伯杆菌1例。并发症:3例患儿在术中出现一过性口唇紫绀或咳嗽剧烈,相应处理后均缓解,5例患儿在术后出现发热和咳嗽加重,经抗感染、雾化等相应对症处理后以上并发症均在2~3天内消失。结论电子支气管镜检查对反复喘息经常规治疗无效的小儿,在病因诊断及治疗具有一定的价值。

Objective To study the clinical value of electronic bronchoscopy in diagnosis and treatment of asthmatic disease in in-fants.Methods Total 68 infants who failed to respond to a routine therapy were examined by electronic bronchoscopy.It was used to identify the pathogeny with the methods of straight inspecting,collecting and examining bronchoalveolar lavage fluid (BALF)specimen.At the same time,therapy with bronchoalveolar lavage(BAL)and inject medicine were performed.Results All the 68 cases diagnosed clearly tracheal bronchial endometritis 32 cases(47.05%),Optimal effect was acquired after bronchoalveolar lavage fluid and administration of drug.there were 14 cases with tracheal stenosis (20.58%),11 patient with airway foreign body(16.17%),foreign body was removed by electronic bronchoscopy in 4 patients.BALF bacterial culture of 1 1 cases(34.37%)were positive,6 cases with Mycoplasma ,2 cases with streptococcus pneumoniae and endobronchial tuberculosis respectively,1 case with klebsiella pneumonia.8 cases of children in the event of paro xymally cy-anosis,a transient fever,cough.All adverse reactions were disappeared after symptomatic therapy.Conclusions There are many causes of asthmatic disease for infants inflammation,airway congenital malformation and bronchial foreign bodies were main reasons for recurrent wheez-ing.Electronic bronchoscopy is useful in the etiologic identification of asthmatic disease in infants,after ineffective with conventional therapy was proved.