纤维支气管镜检查行支气管肺泡灌洗术在儿童慢性肺炎中的诊断与应用价值

The diagnostic and application value of bronchofiberscopy and bronchoalveolar lavage in children with chronic pneumonia

目的探讨纤维支气管镜检查(fiberoptic bronchoscopy,BFS)行支气管肺泡灌洗术(bronchoalveolar lavage,BAL)在儿童慢性肺炎诊断及治疗中的应用价值。方法选取慢性肺炎患儿136例,其中采用常规治疗的68例患儿设为对照组,在常规治疗基础上运用BFS行BAL治疗的68例患儿设为观察组。记录观察组患儿BFS结果与肺泡灌洗液病原检测结果。比较2组临床疗效、症状体征消失时间、动脉血气指标及血清炎症因子水平。监测BFS行BAL可能引起的并发症发生情况。结果观察组68例行BFS的患儿镜下均有不同程度的支气管内膜炎症,其中气道发育异常11例。观察组肺泡灌洗液细菌培养阳性率明显高于痰培养阳性率(P<0.05)。观察组总有效率高于对照组(P<0.05)。观察组发热、咳嗽、肺部湿啰音、哮鸣音消失时间均显著短于对照组(P<0.05)。治疗后,观察组动脉血氧分压(arterial partial pressure of oxygen,PaO2)、酸碱度(power of hydrogen,pH)值明显高于治疗前和对照组,动脉血二氧化碳分压(partial pressure of carbon dioxide in artery,PaCO2)值明显低于治疗前和对照组(P<0.05);对照组治疗前后PaO2、PaCO2、pH值差异无统计学意义(P>0.05)。治疗后,2组血清白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)浓度明显低于治疗前,且观察组IL-6、TNF-α水平低于对照组(P<0.05)。观察组患儿BFS行BAL治疗过程中出现经皮血氧饱和度降低4例,支气管黏膜出血6例,但均较轻微,经对症处理后缓解。结论应用BFS行BAL治疗对儿童慢性肺炎的病因诊断、病原体检测及治疗均具有较高的临床应用价值,患儿耐受性较好。

Objective To explore the application value of fiberoptic bronchoscopy(BFS)and bronchoalveolar lavage(BAL)in diagnosis and treatment of chronic pneumonia in children.Methods A total of 136 children with chronic pneumonia were enrolled in this study.Among them,68 children who received conventional treatment were selected as the control group,and the remaining 68 cases who received combination of conventional treatment and BFS as well as BAL served as the observation group.The results of BFS and pathogen detection in bronchoalveolar lavage fluid were recorded in the observation group.The clinical efficacy,disappearance time of symptoms and signs,arterial blood gas indexes and serum inflammatory factors were compared between the two groups.The possible complications caused by BAL in BFS were monitored.Results All 68 children in the observation group who received BFS showed different degrees of endobronchial inflammation,including 11 cases of airway dysplasia.The positive rate of bacterial culture in BALF was significantly higher than that in sputum culture(P<0.05).The total effective rate of the observation group was higher than that of the control group(P<0.05).The disappearance time of fever,cough,lung moist rales and wheezing sounds in the observation group were significantly shorter than those in the control group(P<0.05).After treatment,the arterial partial pressure of oxygen(PaO2)and power of hydrogen(pH)in the observation group were significantly higher than those before treatment and in the control group.While the values of arterial partial pressure of carbon dioxide(PaCO2)were significantly lower than those before treatment and the control group(P<0.05).There was no significant difference in PaO2,PaCO2 and pH in the control group before and after treatment(P>0.05).After treatment,the serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the two groups were significantly lower than those before treatment,and the levels of IL-6 and TNF-αin the observation group were lower than those in the control group(P<0.05).In the observation group,there were 4 cases of decrease of percutaneous oxygen saturation and 6 cases of bronchial mucosal hemorrhage during the treatment of BFS with BAL,but all of them were mild and relieved after symptomatic treatment.Conclusion The application of BFS in BAL treatment of children with chronic pneumonia has high clinical application value in etiological diagnosis,pathogen detection and treatment.In addition,it is well tolerated in children.