纤维支气管镜在儿童难治性喘息中的应用

Application of fiberoptic bronchoscopy in children with refractory wheezing

目的对82例难治性喘息患儿行纤维支气管镜检查,以积极寻求其病因诊断。方法选取2013年11月至2016年1月在湖南省儿童医院因难治性喘息而行纤维支气管镜检查的82例患儿为研究对象,分析其纤维支气管镜检结果、病原学结果及并发症。结果 82例患儿经纤维支气管镜检查发现,呼吸道异常包括喉软骨软化30例,会厌囊肿3例,声门下不规则瘢痕形成和声门闭合不全2例,先天性喉蹼1例、声门下新生物1例。气管-支气管异常包括气管软化26例,气管上段乳头状瘤1例,气管和局部支气管狭窄23例,气管、支气管异物15例;气管性支气管3例,支气管桥2例;气管食管瘘1例。78例患儿行纤维支气管镜获取肺泡灌洗液并送培养,细菌培养阳性27例(34.6%),真菌培养阳性11例(14.1%)。纤维支气管镜检查最常见的并发症是低氧血症、心率一过性下降,5例患儿出现术后发热。结论纤维支气管镜检查对于寻求难治性喘息患儿的病因有重要的意义。

Objective To find the cause of refractory wheezing by performing fiberoptic bronchoscopy in 82 children with such disease. Methods Totally 82 children with refractory wheezing in Hunan Childreris Hospital from November 2013 to January 2016 were included as the subjects. The results of their fiberoptic bronchoscopy, etiology and complications were analyzed. Results A total of 82 children with refractory wheezing were examined by fiberoptic bronchoscopy, which showed that there were 30 cases of laryngomala- cia,3 cases of congenital epiglottis cyst,2 cases of subglottic scar formation and glottic insufficiency, 1 case of congenital laryngeal web and 1 case of subglottic neoplasia. Trachea-bronchial abnormalities included 26 cases of tracheomalacia, 1 case of papilloma of trachea,23 cases of trachea-bronchial stenosis, 15 cases of tra-chea-bronchial foreign body,3 cases of tracheal bronchus,2 cases of bridging bronchus and 1 case of tracheo-esophageal fistula. Totally 78 children underwent fiberoptic bronchoscopy and bronchoalveolar lavage fluid was obtained and cultured; bacterial culture was positive in 27 cases（34. 6%） , and fungal culture was posi-tive in 11 cases （14. 1%）. The most common complications of fiberoptic bronchoscopy were hypoxia and transient decline of heart rate; 5 cases had fever after operation. Conclusion Fiberoptic bronchoscopy is of great significance to the children with refractory wheezing.