软式支气管镜及塑型取出术在儿童塑型性支气管炎中的应用及护理要点

Application of flexible bronchoscopy and molding removal in pediatric plastic bronchitis and nursing considerations

目的评估经软式支气管镜塑型取出术在儿童塑型性支气管炎(plastic bronchitis,PB)中的应用,并总结护理要点。方法回顾性分析2019年1月至2023年12月广州医科大学附属妇女儿童医疗中心呼吸科收治的PB患者,收集患者性别、年龄、支气管镜检查时机、塑型取出术的方法及时间、并发症以及并发症的护理。结果22例PB儿童患者,男17例,女5例,中位年龄3.00(1.42,5.25)岁。术中喷洒乙酰半胱氨酸溶液后经负压吸引取出塑型患者11例(50.00%),经活检钳钳取塑型患者3例(13.64%),经毛刷刷取出塑型8例(36.36%)。塑型取出术中支气管操作中位时间为11.50(9.75,15.25)min。塑型取出术中气管镜反复经过声门的中位次数为4(3,5)次。行1次支气管检查患者6例(27.27%),2次支气管镜检查患者12例(54.55%),3次支气管检查患者4例(18.18%)。常见并发症为术中缺氧(8例,36.36%)、气道黏膜出血(4例,18.18%)、术后缺氧(2例,9.09%)、喉头水肿(1例,4.55%),经相应处理及护理后,并发症均缓解。结论软式支气管镜检查及塑型取出术对于儿童PB患者安全有效,并发症少,术中喷洒乙酰半胱氨酸溶液配合负压吸引、活检钳钳取、毛刷刷取等方式可以提高取出塑型的成功率。

Objective To evaluate the application of flexible bronchoscopy for the removal of molds in children with plastic bronchitis(PB)and to summarize key nursing considerations.Methods A retrospective analysis was conducted on PB patients treated at the Respiratory Department,Guangzhou Medical University affiliated Women and Children′s Medical Center from January 2019 to December 2023.Data were collected on patient demographics,timing of bronchoscopy,methods and duration of mold removal,complications,and nursing management of complications.Results The study cohort comprised 22 pediatric PB patients(17 males and 5 females)with a median age of 3.00 years(IQR:1.42 to 5.25 years).The mold removal techniques applied were spraying acetylcysteine solution followed by negative pressure suction(11 cases,50.00%),biopsy forceps extraction(3 cases,13.64%)and brush extraction(8 cases,36.36%).The median duration of bronchoscopic manipulation for mold removal was 11.50 minutes(IQR:9.75 to 15.25 minutes).The median number of bronchoscope passes through the glottis was 4(IQR:3 to 5).Bronchoscopic examinations were conducted once in 6 patients(27.27%),twice in 12 patients(54.55%),and three times in 4 patients(18.18%).Common complications included intraoperative hypoxia(8 cases,36.36%),airway mucosal bleeding(4 cases,18.18%),postoperative hypoxia(2 cases,9.09%),and laryngeal edema(1 cases,4.55%).All complications were effectively managed with appropriate interventions and nursing care.Conclusion Flexible bronchoscopy combined with various mold removal techniques is a safe and effective approach for managing PB in children,with manageable complications.The use of acetylcysteine solution spray in conjunction with negative pressure suction,biopsy forceps,and brush extraction enhances the success rate of mold removal.Proper nursing interventions are crucial for minimizing and managing procedural complications.