纤维支气管镜在小儿先天性心脏病呼吸道病变诊疗中的应用  

Application of Fiberoptic Bronchoscopy on Diagnosis and Treatment of Respiratory Comorbidity in Children with Congenital Heart Disease

作　　者：杨泽玉[1] 梁磊[1] 刘文君[1] 张琪[1] 金丹群[1] 江荣[1] 丁力[1] 毕良学[1] 

机构地区：[1]安徽省立儿童医院儿科,合肥230051

出　　处：《实用儿科临床杂志》2011年第4期260-261,共2页Journal of Applied Clinical Pediatrics

基　　金：安徽省卫生厅科研基金(09C197)

摘　　要：目的探讨纤维支气管镜(FB)在小儿先天性心脏病(CHD)呼吸道病变诊疗中的应用价值。方法选取2006年7月-2010年5月在本院因难治性肺炎、肺不张、反复或持续性喘息、呼吸机依赖、CHD术前术后呼吸道病变评估等而住院的CHD患儿72例,应用O lympus BF-3C40镜,在常规局部浸润麻醉下进行FB检查,并对其中12例合并肺不张患儿进行支气管肺泡灌洗(BAL)治疗。结果镜下发现CHD患儿呼吸道病变以炎症及呼吸道阻塞性改变多见,分别占88.9%和72.2%。其中气管或支气管外压性狭窄46例,气管或支气管软化8例,喉软化5例,右侧气管源性支气管4例,血管环、气管下段及右主支气管先天性狭窄、左侧声带麻痹各1例;合并肺动脉高压(PH)者呼吸道外压性狭窄发生率(91.3%)较无PH者(19.2%)明显增高;对12例肺不张患儿行BAL治疗,治愈7例;术中31例(43.1%)出现一过性低氧血症,但无严重并发症发生。结论炎性反应和气管或支气管狭窄及软化是CHD患儿常见的呼吸道病变,PH是导致呼吸道外压性狭窄的重要因素,FB在小儿CHD呼吸道病变评估中不仅能发挥诊断作用,而且可发挥治疗作用,且相对安全。Objective To explore the diagnostic and therapeutic value of fiberoptic bronchoscopy（FB） on respiratory comorbidity in children with congenital heart disease（CHD）.Methods Seventy-two children with CHD and concomitant refractory pneumonia,atelectasis,recurrent or persistent wheezing,prolonged mechanical ventilation and preoperative or postoperative evaluation of airways were admitted in hospital and selected in this study from Jul.2006 to May 2010.FB Olympus BF-3C40 was applied after routine local infiltration anesthesia.Twelve children with atelectasis were treated with bronchoalevoar lavage（BAL） simultaneously.Results Respiratory inflammation and obstructive comorbidity were more common in children with CHD（88.9% and 72.2%,respectively）,including 46 cases with tracheobronchial stenosis caused by extrinsic compression,8 cases with tracheomalacia or bronchomalacia,5 cases with laryngealmalacia,4 cases with trachealbronchus.Besides,1 child with vessel ring,1 child with inferior segment tracheal congenital stenosis and 1 child with right main bronchial congenital stenosis,1 child with left vocal cord paralysis,respectively.The incidence of tracheobronchial stenosis caused by extrinsic compression in the children with PH was significantly greater than those in children without PH（91.3% vs 19.2%）.Seven cases were cured among the 12 children with atelectasis treated with BAL.Transient hypoxemia were found in 31 cases（43.1%）.No severe complication was found in both groups.Conclusions Respiratory inflammation,tracheobronchial stenosis,tracheomalacia and bronchomalacia are common in children with CHD,PH is an important risk factor of tracheobronchial stenosis caused by extrinsic compression.FB is a relatively safe evaluation tool in the diagnosis and intervention treatment in the children with CHD and respiratory comorbidity.

关 键 词：纤维支气管镜 心脏病 先天性 呼吸道病变 支气管肺泡灌洗 儿童 

分 类 号：R725.4[医药卫生—儿科]