儿童重症监护病房可弯曲支气管镜下形态学诊断分析

Morphological diagnosis of pediatric flexible bronchoscopy in pediatric intensive care unit

目的通过形态学诊断分析可弯曲支气管镜术在诊断儿童重症监护病房(PICU)呼吸道疾病患儿中的临床应用价值。方法回顾性分析2017年7月至2022年12月兰州大学第二医院PICU收治的124例呼吸系统危重症行床旁电子支气管镜术后形态学异常患儿的临床资料,其中96例行支气管肺泡灌洗液(BALF)病原学检查,3例进行引导经鼻气管插管术。比较电子支气管镜和胸部CT诊断肺部病变准确性的差异,并观察电子支气管镜下肺部病变的形态学变化。结果电子支气管镜检查对于气管食管瘘、气管断裂、支气管异物诊断的准确性明显高于胸部CT(气管食管瘘:4例比0例,气管断裂:4例比0例,支气管异物:4例比6例,均P<0.05),电子支气管镜检查和胸部CT对于肺挫伤、支气管扩张诊断的准确性比较差异无统计学意义。镜下确诊典型病例:气管食管瘘4例(3.23%);支气管断裂伤4例(3.23%);支气管赞生物并黏膜附着白色干酪样物1例(0.81%),镜下诊断为支气管内膜结核。病原学检出阳性细菌23例(23.96%)。因患儿颌骨或颈椎骨折行引导经鼻气管插管术3例;机械通气下经气管导管进镜操作13例。术中和术后无严重并发症及死亡病例结论PICU开展儿科可弯曲支气管镜术安全可靠,可提高PICU呼吸系统疾病的确诊率,有较高的临床应用价值。

Objective To investigate the clinical application value of pediatric electronic bronchoscopy on the diagnosis of respiratory disease in the pediatric intensive care unit(PICU)by morphological diagnosis.Methods The clinical data of 124 patients with PICU respiratory critically ill patients who underwent bedside electronic bronchoscopy from July 2017 to December 2022 in Lanzhou University Second Hospital were retrospectively analyzed.Pathogen examination of 96 cases of bronchoalveolar lavage fluid(BALF),bronchoscopy guided nasal endotracheal intubation in 3 cases was conducted.The accuracy of diagnosis of lung lesions was compared between electronic bronchoscopy and chest CT,and the morphological changes of lung lesions under electronic bronchoscopy were observed.Results The accuracy of electronic bronchoscopy in the diagnosis of tracheoesophageal fistula,tracheoesophageal rupture and bronchial foreign body is significantly higher than that of chest CT(tracheoesophageal fistula:4 cases vs.O case,tracheoesophageal rupture:4 cases vs.0 case,bronchial foreign body:4 cases vs.6 cases,all P<0.05),and there was no significant difference in the accuracy of diagnosis of lung contusion and bronchiectasis between electronic bronchoscopy and chest CT.Typical cases confirmed under endoscopic:4 cases(3.23%)had tracheoesophageal fistula.Bronchial rupture 4 cases(3.23%).Endobronchial tuberculosis was diagnosed in 1 case(0.81%)with bronchial neoplasms and white caseous material attached to the mucosa.Positive bacteria were detected in 23 cases(23.96%).Guided nasotracheal intubation was performed in 3 children with jaw or cervical fracture.Endotracheal catheterization under mechanical ventilation was performed in 13 cases.There were no serious complications and death during and after the operation.Conclusion Pediatric bendable bronchoscopy with PICU is safe and reliable.It can improve the diagnosis rate of respiratory diseases in PICU,and has high clinical application value.