纤维支气管镜和肺泡灌洗术在肺不张诊断和治疗中的价值  

Values of Fiberoptic Bronchoscopy and Bronchoalveolar Lavage in Diagnosis and Treatment of Atelectasis in Children

作　　者：顾浩翔[1,2] 陆敏[1,2] 车大钿[1,2] 董晓艳[1,2] 张慧燕[1,2] 吴蓓蓉[1,2] 李爱华[1,2] 

机构地区：[1]上海市儿童医院 [2]上海交通大学附属儿童医院呼吸科,上海200040

出　　处：《实用儿科临床杂志》2012年第4期262-264,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的评估纤维支气管镜检查和肺泡灌洗术对儿童肺不张病原诊断和治疗的价值。方法回顾性分析本院2008年1月-2009年12月诊断和治疗的肺不张患儿122例。分析患儿实验室检查、辅助检查、气管镜检查及支气管肺泡灌洗术资料,总结病因,并对比感染性肺不张患儿纤维支气管镜治疗与非纤维支气管镜治疗的效果。结果 122例肺不张患儿中非感染性肺不张11例,其中肺炎先天性支气管发育异常7例,异物吸入4例;感染性肺不张111例,其中肺炎支原体检出阳性81例,细菌检出阳性50例,病毒检出阳性7例,结核1例,未检出病原14例。感染性肺不张纤维支气管镜治疗组有效51例,未愈4例,有效率为92.72%;非纤维支气管镜治疗组有效42例,未愈14例,有效率为75.00%,2组有效率比较差异有统计学意义(P<0.05)。纤维支气管镜镜检可见支气管开口分泌物、痰栓堵塞,炎性狭窄、软化及异物嵌顿部位肉芽组织增生、内膜结核干酪样变、破溃。结论小儿肺不张最常见的原因是感染,主要病原为肺炎支原体和细菌。纤维支气管镜检查、肺泡灌洗术及肺泡灌洗液检查对明确病因和治疗有重要作用。Objective To assess the values of fiberoptic bronchoscopy and bronchoalveolar lavage for etiologically diagnosis and treatment of atelectasis in children. Methods One hundred and twenty-two patients with atelectasis,who were diagnosed and treated in Shanghai Children′s Hospital from Jan.2008 to Dec.2009,were retrospectively analyzed.The etiology was summarized by laboratory tests,auxiliary examinations,fiberoptic bronchoscopy bronchoalveolar lavage.The therapeutic effects of patients with infectious atelectasis were compared between the bronchoscopy treatment group and non-bronchoscopy treatment group. Results In the 122 children with atelectasis,11 patients suffered from non-infectious atelectasis,including 7 patients with congenital bronchial dysplasia and 4 patients with aspiration of foreign body;111 patients suffered from infectious atelectasis,including 81 patients with positive mycoplasma pneumoniae,50 patients with positive bacterial detection,7 patients with positive viral detection,1 patient with tuberculosis,and 14 patients with unexplained pathogen.In the bronchoscopy treatment group,51 patients were recovered while 4 patients remained uncured,the total effective rate was 92.72%;in the non-bronchoscopy treatment group,42 patients were recovered while 14 patients were uncured,the total effective rate was 75.00%,there was statistical difference between the 2 groups（P〈0.05）.The fiberoptic bronchoscopy detection results included secretion in the bronchial ope-ning,obstruction by phlegm and embolism,inflammatory stricture,malacia,congenital stenosis,hyperplasia of granulation tissues,caseation and ruptured ulceration. Conclusions The most common etiology of atelectasis in children are infection,mainly caused by mycoplasma pneumoniae and bacteria.Fiberoptic bronchoscopy,bronchoalveolar lavage method and examination of bronchoalveolar lavage fluid play irreplaceable roles in determining the etiology and therapy of atelectasis.

关 键 词：纤维支气管镜 肺泡灌洗术 肺不张 诊断 治疗 儿童 

分 类 号：R725.6[医药卫生—儿科]