纤维支气管镜在新生儿科的应用

Application of fiber-optic bronchoscopy in neonatology

目的探讨纤维支气管镜在新生儿科的应用价值及安全性。方法选择2012年7月至2015年12月我院行纤维支气管镜检查的新生儿,分析其疾病特征,记录检查前、中、后经皮血氧饱和度(SpO_2)、心率、血压,检查前、检查后30 min血气分析,以及检查中发生的并发症情况。结果共检查42例患儿,完成44例次检查,检出呼吸道异常40次,呼吸道异常检出率为90.9%。其中喉软化22例,占52.4%;气管、支气管软化或狭窄19例,占45.2%,确诊气管食管瘘1例,检查吻合率为73.8%。SpO_2在检查前、中、后的变化差异有统计学意义(P<0.05)。检查过程中患儿SpO_2下降,与检查前比较差异有统计学意义[(0.80±0.15)比(0.95±0.04),P<0.05],检查后可恢复,与检查前比较差异无统计学意义[(0.94±0.02)比(0.95±0.04),P>0.05]。检查过程中6例患儿出现心率下降,停止操作并加压给氧后恢复正常,血压无明显变化,监测血气分析均正常,未出现肺出血、心力衰竭等严重并发症。结论纤维支气管镜在新生儿科的应用具有一定的安全性和诊断价值,可提高新生儿呼吸系统疾病的临床诊治水平。

Objective To study the clinical value and safety of fiber-optic bronchoscopy（ FB）in the neonatal department. Methods From July 2012 to December 2015,42 neonates admitted to the neonatal department of our hospital who received FB examination were enrolled in this prospective study.Their clinical data including clinical manifestations,complications,transcutaneous oxygen saturation（ SpO_2）,heart rate,blood pressure and arterial blood gas（ ABG） analysis before and after the examinations were recorded and analyzed. Results A total of 44 episodes of FB examinations were performed among all 42 neonates. The positive rate of airway abnormalities findings was 90. 9%.22 neonates with laryngomalacia（ 52. 4%）,19 cases tracheobronchomalacia or tracheal stenosis（ 45. 2%）,and 1 tracheoesophageal fistula. The consistency of positive FB findings and clinical manifestations was 73. 8%. The SpO_2 during the FB examination was significantly lower than before the examination（ 0. 95 ± 0. 04 vs. 0. 80 ± 0. 15,P〈0. 05）. No significantly differences existed between SpO_2 before and after the examination（ 0. 95 ± 0. 04 vs. 0. 94 ± 0. 02,P〉0. 05）. Heart rate decreased in 6 cases and returned to normal quickly after stopping FB and positive airway pressure treatment. All the 6 patients had normal blood pressure and ABG. None of them had severe complications,neither pulmonary hemorrhage nor heart failure. Conclusions FB is valuable and relatively safe in neonatal department. It can improve the diagnosis and treatment of neonatal respiratory system disease.