纤维支气管镜肺泡灌洗技术在小儿脓胸外科治疗中的应用研究

Application of alveolar wash technique with fiber brochoscope in surgical treatment of pyothorax in children

目的探讨纤维支气管镜肺泡灌洗治疗小儿脓胸的疗效。方法回顾性分析2007年1月至2016年12月收治的小儿脓胸患者402例,随机分对照组和试验组,其中对照组202例采用传统方法治疗,试验组200例在对照组基础上加纤维支气管镜肺泡灌洗治疗。结果 2组患儿炎性指标无明显差异:2组体温(P=0.812),白细胞(WBC)(P=0.372),C-反应蛋白(P=0.674)。试验组患儿纤维支气管镜检查结果:患儿均有支气管黏膜充血水肿,支气管分泌物堵塞51例(25.5%),支气管脓栓堵塞38例(19.0%),支气管内膜存在溃疡32例(16.0%),支气管异物5例(2.5%);术后2例出现喉水肿,对症治疗后消失。2组患儿病原学检查,包括血、胸水及肺泡灌洗液细菌培养结果:肺炎链球菌检出居首位,其次是金黄色葡萄球菌。2组抗生素使用时间、住院天数、开胸手术发生率、致残率比较,差异均有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗术治疗小儿脓胸可有效减轻炎性反应、缩短抗生素使用时间及住院时间、降低致残率,在小儿脓胸外科治疗中安全有效。

Objective To investigate the curative effects of alveolar wash technology with fiber brochoscope on pyothorax in children.Methods The clinical data about 402 child patient with pyothorax who were admitted and treated in our hospital from January 2007 to December 2016 were retrospectively analyzed, and these patients randomly divided into control group(n=202) and experimental group(n=200).The patients in control group were treated by traditional treatment, however,the patients in experimental group were treated by fibrobronchoscope alveolar lavage.Results There were no significant differences in inflammatory indexes, body temperature, WBC count and C reaction protein between the two groups(P>0.05).The results of fiberoptic bronchoscopy in experimental group showed that all the patients had endobronchial congestion and edema, 25.5% of the patients had a bolckage of bronchial secretions, 19.0% of the child patients had a bolckage of bronchial pus embolus, 16.0% of patients had anabrosis in bronchial intima, and 2.5% of patients had foreign body in bronchus. Moreover postoperative laryngeal edema occurred in 2 cases and disappeared after symptomatic treatment. The results of etiological examination including the bacterial culture of blood, pleural fluid and alveolar lavage fluid showed that streptococcus pneumoniae was dominant, followed by staphylococcus aureus. There were signficant differences in curative effects,prognostic indexes, antibiotic use time, length of hospital stay, incidence of thoracotomy, disability rate between the two groups(P<0.05).Conclusion The fibrobronchoscope alveolar lavage in treatment of pyothorax in children can effectively relieve inflammatory reaction, shorten antibiotic use time and length of hospital stay, and reduce disability rate, which is safe and effective in surgical treatment of pyothorax in children.