新生儿纤维支气管镜应用的临床分析

Clinical analysis of flexible bronchoscopy in neonates

目的分析新生儿纤维支气管镜的检查结果和临床资料,总结纤维支气管镜临床应用的指征、结果及与疾病的相关性。方法回顾性分析2017年5月至2019年3月该院共51例纤维支气管镜检查的新生儿临床资料及共52例次的镜检结果,分析内镜检查结果与镜检指征、临床疾病的相关性。结果52例次的镜检指征:呼吸困难24例次(46.2%)、影像学异常22例次(42.3%)、撤机困难12例次(23.1%)、持续喉鸣12例次(23.1%)和喂养困难5例次(9.6%)。在适用内镜检查的指征上,有18例次(34.6%)为单一指征,34例次(65.4%)为2个或3个指征。52例次的内镜检查中,发现病理改变50例次,病变检出率为96.2%。其中内膜感染30例次(60.0%),喉软化22例次(44.0%),声门异常10例次(20.0%),气管及支气管狭窄8例次(16.0%),气管及支气管软化7例次(14.0%),气管食管瘘2例次(4.0%)和气管发育畸形并狭窄1例次(2.0%);支气管肺泡灌洗时发现肺出血1例,灌洗液病原学检查诊断肺结核1例;并发症少见且很轻微。结论纤维支气管检查应用于新生儿是有效且安全的。严格把握支气管镜检查的指征,可提高检查病变检出率。

Objective To analyze the results of flexible bronchoscopy(FB)and clinical data,and to summarize the indications and results of clinical application of flexible bronchoscopy and its correlation with disease.Methods A retrospective study on clinical data of 51 neonates undergoing flexible bronchoscopy and the 52 times of microscopy results from May 2017 to March 2019 were enrolled.The correlation among endoscopic findings,microscopic indications and clinical disease were analyzed.Results The indications for 52 times were 24 respiratory distress(46.2%),22 radiographic abnormalities(42.3%),12 weaning failure(23.1%),12 persistent stridor(23.1%)and 5 feeding difficulties(9.6%).On the indications applicable to endoscopic examination,18(34.6%)were done for one indication as 34(65.4%)were for two or three indications.In 52 times of endoscopic examination,there were 50(96.2%)pathological changes,including 30(60.0%)endobronchitis,22(44.0%)laryngomalacia,10(20.0%)glottal abnormalities,8(16.0%)trachea or bronchial stenosis,7(14.0%)trachea or bronchial malacia,2(4.0%)tracheoesophageal fistula,and 1(2.0%)trachea abnormality and stenosis.1 pneumorrhagia was diagnosed by bronchoalveolar lavage as 1 tuberculosis diagnosed by bronchoalveolar lavage fluid.Complications were rare and mild.Conclusion Flexible bronchoscopy is useful and safe for neonates,and strict control of the indications of bronchoscopy can improve the detection rate.