纤维支气管镜在儿童塑形性支气管炎诊治中的价值研究

Study on value of fiberoptic bronchoscopy in diagnosis and treatment of plastic bronchitis in children

目的探讨纤维支气管镜在儿童塑性形支气管炎诊治中的作用。方法对该院2013年5月至2015年6月收治的28例经纤维支气管镜诊治的塑形性支气管炎患儿进行回顾性分析。结果所有28例患儿均经纤维支气管镜确诊,28例一次操作16例(57.1%),两次操作8例(28.6%),两次以上操作4例(14.3%)。26例(92.9%)临床症状明显缓解,低氧血症明显纠正,影像学提示肺部阴影区充气明显改善。20例顺利脱呼吸机,2例反复脱呼吸机失败,1例死亡,1例放弃治疗。1例术后出现脑损伤,2例出院后再入院。28例均进行了灌洗液病原菌送检,其中检出肺炎支原体(MP)10例(35.6%),甲型流感病毒10例(35.6%),腺病毒2例(7.2%),副流感病毒1例(3.6%),肺炎克雷伯菌1例(3.6%),鲍曼不动杆菌1例(3.6%),铜绿假单胞菌1例(3.6%),白色假丝酵母菌1例(3.6%),MP+副流感混合感染1例(3.6%)。结论对于儿童塑性形支气管炎,纤维支气管镜技术是惟一种快速、有效的诊断和治疗方法。

Objective To investigate the role of fiberoptic bronchoscopy in the diagnosis and treatment of plastic bronchitis in children. Methods A total of 28 children patients with plastic bronchitis diagnosed and treated by plastic bronchitis in our hospi- tal from May 2013 to June 2015 were analyzed retrospectively. Results All the 28 cases were confirmed by fiberoptic bronchosco- py, 16 cases （57.1% ） received once therapeutic fiberoptic bronchoscopy, 8 cases（28.6 %） received twice therapeutic fiberoptie bron- choscopy and 4 cases（14.3 %） received more than twice therapeutic fiberoptic bronchoscopy. The clinical symptoms,hypoxemia and lung shadow by imaging were significantly improved in 26 cases（92.9 %）. Twenty cases were successful in taking off breathing ma- chine and 2 cases failed in taking off breathing machine. One case died and another case gave up treatment. One＇case appeared cere- bral injury and 2 cases were re-admitted after discharge. All cases were performed the irrigation solution pathogen examination. A- mong them, mycoplasma pneumonia（MP） was detected in 10 cases （35.6 % ）, influenzae A virus in 10 cases（35.6 %）, adenovirus in 2 cases（7.2 % ）, parainflUenza virus in 1 case（3.6 %）, klebsiella pneumonia in 1 case （3.60% ） % baumanii in 1 case（3.6 % ）, pseudo- monas aeruginosa in 1 case（3.6%%）, candida albicans in 1 case（3. 6%） and mixed infection by MP and parainfluenza in 1 case （3.6 %）. Conclusion Fiberoptic bronchoscopy is the only fast and effective diagnosis and treatment method of plastic bronchitis.