纤维支气管镜肺泡灌洗术治疗新生儿肺炎中应用

Application of fibrobronchoscopic alveolar lavage in the treatment of neonatal pneumonia

目的探讨BAL治疗新生儿肺炎中应用。方法选取2019年1月-2022年6月在玉溪市儿童医院新生儿科住院行纤维支气管镜肺泡灌洗的35例新生儿为研究对象,回顾性分析纤支镜检查结果、支气管肺泡灌洗结果以及手术前后相关指标的变化。结果35例患儿中,胎粪吸入综合征14例(40%),新生儿肺炎和/或肺不张、吸气性呼吸困难21例(60%)。均做了纤维支气管镜灌洗并送检了病原学,其中23例阴性(65.7%),12例阳性(34.2%)。临床转归结果,33例好转出院(94.2%),2例放弃治疗(5.7%)。检查前后,WBC、PCT、CRP没有明显变化,术后1h行血气分析PO_(2)、PCO_(2)较前有改善,差异有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗对难治性新生儿肺炎治疗效果较好,在NICU中应用相对安全。

Objective To explore the application of fibrobronchoscopic alveolar lavage(BAL)in the treatment of neonatal pneumonia.Methods Thirty five newborns who were hospitalized in the neonatal department of Yuxi Children's Hospital from January 2019 to June 2022 who underwent fibrobronchoscopic alveolar lavage were selected as the study subjects.The results of fibrobronchoscopic,bronchoalveolar lavage and the changes of relevant indexes before and after the operation were analyzed retrospectively.Results Among the 35 newborns,14(40%)had meconium aspiration syndrome,21(60%)had neonatal pneumonia and/or atelectasis and inspiratory dyspnea.All patients underwent fibrobronchoscopic alveolar lavage and examined for etiology.Among them,23 cases were negative(65.7%)and 12 cases were positive(34.2%).The clinical outcome showed that 33 patients(94.2%)were discharged from hospital and 2 patients(5.7%)gave up treatment.Before and after the examination,WBC、PCT and CRP had no significant changes.PO_(2)and PCO_(2)were improved by blood gas analysis at 1h after the operation,and the difference was statistically significant(P<0.05).Conclusions Fibrobronchoscopic alveolar lavage is effective in treating refractory neonatal pneumonia and is relatively safe in NICU.