支气管镜检查在儿童喘息性疾病诊治中的应用  

Application of bronchoscopy in diagnosis and treatment of recurrent wheezing diseases in children

作　　者：张奕[1] 郑宝英[1] 崔菲菲[1] 朱春梅[1] 曹玲[1] 

机构地区：[1]首都儿科研究所附属儿童医院呼吸科,北京100020

出　　处：《中国医刊》2016年第11期57-59,共3页Chinese Journal of Medicine

摘　　要：目的探讨支气管镜检术对儿童反复喘息性疾病的诊断及治疗价值。方法收集本院2009年1月至2016年1月因反复喘息住院并应用支气管镜诊疗的743例患儿的临床资料。所有病例均在局部黏膜表面麻醉下行支气管镜检术,通过镜下直视、支气管肺泡灌洗液病原学检查进一步明确病因,行支气管肺泡灌洗及药物治疗,并评判其疗效和并发症发生情况。结果 743例反复喘息患儿镜下表现：支气管内膜炎437例（58.8%）,气管支气管狭窄、软化171例（23.0%）、支气管异物81例（10.9%）、分泌物壅塞33例（4.4%）、气管食管瘘4例（0.5%）、喉软骨软化3例（0.4%）等。不同年龄段喘息患儿支气管镜下病因构成比有所不同,各年龄段均以支气管内膜炎症为主要镜下表现,其次为气管、支气管狭窄、软化和支气管异物、分泌物壅塞,其中在1-3岁年龄组支气管异物所占比例明显增高,≥4岁患儿炎性改变所占比例明显升高。通过支气管镜灌洗、取异物及外科手术治疗原发病,患儿症状多可好转。结论小儿反复喘息的病因以炎症、先天性发育异常及呼吸道异物多见,婴幼儿反复喘息应警惕先天性心肺发育异常及呼吸道异物。支气管镜检查对儿童反复喘息的病因诊断具有重要价值。支气管镜检查安全、便捷、并发症少。Objective To explore the clinical value of bronchoscopy in diagnosis and treatment of wheezing diseases in children.Method Clinical data of 743 pediatric patients with recurrent wheezing were retrospectively analyzed from Department of Respiratory in our Hospital from Jan 2009 to Jan 2016.Under local anesthesia,bronchoscopy was used to identify the pathogeny with the methods of straight inspect,bronchoalveolar lavage fluid examine,and therapy with bronchoalveolar lavage and inject medicine were performed.Result Through bronchofibroscopy,there were 437 cases with inflammation（58.8%）,171 cases with bronchomalacia and/or tracheal stenosis（23.0%）,81 cases with bronchial foreign bodies（10.9%）,33 cases with secretion of congestion（4.4%）,4 cases with tracheaesophageal fistula（0.5%）,and 3 cages with laryngomalacia（0.4%）,etc.The bronchoscopy examination discovered that there are different pathogeny constituent ratios in different age group;the inflammation is the primary manifestation,followed by bronchomalacia and/or tracheal stenosis,bronchial foreign bodies,secretion of congestion.The ratio of bronchial foreign bodies at the age 1-3 and the ratio of inflammation at the age ≥4 increased obviously.Conclusion Inflammation,airway congenital malformation andbronchial foreign bodies were main reasons for recurrent wheezing.Airway congenital malformation and bronchial foreign bodies must be care of in infants who had recurrent wheezing.Bronchoscopy is useful in the etiologic identification of recurrent wheezing in children.The bronchoscopy examination was safe,convenient and had less complications.

关 键 词：支气管镜 喘息 诊断 治疗 儿童 

分 类 号：R725.6[医药卫生—儿科]