纤维支气管镜检查和肺泡灌洗术在重症肺部感染中应用意义  

The application of fiberoptic bronchoscope and alveolar lavage treatment on severe lung infection

作　　者：范江花[1] 张新萍[1] 胥志跃[1] 周雄[1] 杨梅雨[1] 邱喻 刘美华[1] 肖政辉[1] 祝益民[1] 

机构地区：[1]湖南省儿童医院急救中心,长沙410007

出　　处：《中国小儿急救医学》2015年第7期449-453,共5页Chinese Pediatric Emergency Medicine

基　　金：十二五国家科技支撑计划（2012BA104801）

摘　　要：目的评估纤维支气管镜和肺泡灌洗术治疗在PICU重症肺部感染的诊断、治疗价值及安全性。方法回顾性分析我院PICU2012年3月至2014年2月收治的263例重症肺部感染患儿327例次纤维支气管镜检查资料，并收集同期108例家属不同意行纤维支气管镜检查肺部感染患儿为对照组，比较肺泡灌洗术治疗后与对照组的临床表现、实验室资料情况。结果（1）肺泡灌洗液培养主要菌谱以革兰阴性菌为主，支气管肺泡灌洗液培养阳性率53．99％（142／263）。（2）炎症病变为反复难治性肺炎或肺不张的首要病因[93．90％（231／246）]；伴气道发育异常90．24％（222／246），其中气管支气管软化占76．58％（170／222）。不同年龄段患儿气道原发病变不同，差异有统计学意义（χ^2=25．886，P=0．000）。（3）先天性心脏病合并肺动脉高压患儿气管支气管软化发生率（94．19％）较无肺动脉高压患儿（38．09％）明显增高（P〈0．05）。（4）与对照组相比，经纤维支气管镜行肺泡灌洗治疗后患儿发热、咳嗽、喘息、肺部哕音及肺不张等临床症状明显缓解，感染指标C反应蛋白、降钙素原明显降低，PaO2、氧合指数（P／F）及SaO2升高，差异均有统计学意义（P均〈0．05）。结论纤维支气管镜术和支气管肺泡灌洗术对重症肺部感染尤其是难治性肺炎或肺不张患儿有着重要作用，可直接清除肺内痰液分泌物，保持气道通畅，缩短病程，是诊断气道发育异常及支气管异物的有效手段，并且安全有效。Objective To assess the diagnosis, therapeutic value and safety of the fiberoptic bronchoscope and alveolar lavage treatment on severe lung infection in PICU. Methods A total of 263 cases of severe lung infection that admitted to the PICU of Hu＇nan Children＇s Hospital during March lst,2012 to February 28th,2014 were retrospectively selected as bronchoscope treatment group, which underwent 327 times of bronchoscopy treatment. We also collected 108 children with lung infection whose family disagreed with fiberoptic bronchoscope treatment in the same period as the control group. Clinical manifestations and results of laboratory tests were compared between the bronchoscope treatment group and the control group. Results （ 1 ） Gram-negative bacterium was the mainly bacterial spectrum in bronchoalveolar lavage fluid of bronchoscope treatment group,and the culture-positive rate was 53.99% （142/263）. （2） The mainly cause of repeated or refractory pneumonia or atelectasis was inflammation infection, accounting for 93.90% （231/246）, the rate of airway abnormalities was 90. 24 % （222/246） when tracheobronchomalacia accounting for 76. 58 % （ 170/ 222）. The primary lesions of airway were different significantly among different age groups （χ^2 = 25. 886, P = 0. 000 ）. （ 3 ） The rate of tracheobronchomalacia in cases of congenital heart disease with pulmonary hypertension was 94. 19%, which was significantly higher than those without pulmonary hypertension （38. 09% ）（P 〈0. 05）. （4）None serious complications happened to the children of bronchoscope treatment group. The clinical symptoms of fever, cough, breathing, pulmonary tribal sounds and atelectasis were relieved in bronchoscope treatment group compared with the control group. The inflammation indicators as C-reactive protein and procalcitonin decreased significantly in bronchoscope treatment group than those of control group （ P 〈 0. 05 ）, while PaO2, oxygenation index and SaO2 increased （ P 〈 0. 05 ）. Conclusion

关 键 词：纤维支气管镜 肺泡灌洗术 肺部感染儿童 

分 类 号：R725.6[医药卫生—儿科]