软式支气管镜在儿童呼吸系统疾病中的应用  

Application of flexible bronchoscopy in children with respiratory diseases

作　　者：王丽萍[1] 陈守平[1] 黄玉瑛[1] 秦芳芳[1] 欧文[1] 刘洪栋[1] 邓小芳 娄磊[1] 陶静[1] 崔玉霞[1] 

机构地区：[1]贵州省人民医院儿科,贵州贵阳550002

出　　处：《中国当代儿科杂志》2017年第11期1174-1179,共6页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨软式支气管镜在儿童呼吸系统疾病中的临床应用价值。方法对80例因呼吸系统疾病住院(包括重症肺炎、肺炎支原体肺炎并肺不张/肺实变/局限性肺气肿、迁延性肺炎、咳喘原因待查、慢性咳嗽查因、喉喘鸣)接受软式支气管镜检查/肺泡灌洗治疗患儿的临床资料进行回顾性分析。结果支气管镜检查发现,80例患儿均有支气管内膜炎症,其中分泌物严重雍塞气道28例。在支气管内膜炎症基础上合并先天性气道发育异常24例,另发现支气管异物3例。咳喘原因待查及喉喘鸣的患儿中,部分患儿存在先天性气道发育异常或支气管异物等病变。27例肺炎支原体肺炎患儿中,分泌物严重雍塞/栓塞气道26例;25例患儿(93%)在肺泡灌洗治疗后2周复查胸部影像学,显示肺部完全或大部分复张。行支气管镜检查的80例患儿中,术中出现严重低氧血症3例,鼻出血1例,肺泡灌洗术中少量出血1例,支气管短暂性痉挛3例,术后发热5例,均经对症处理后好转。结论软式支气管镜在儿童呼吸系统疾病的临床应用是安全可靠的。重症/难治性肺炎支原体肺炎患儿建议早期行软式支气管镜下肺泡灌洗治疗,可改善预后。反复咳喘及持续喉喘鸣患儿均建议积极行软式支气管镜检查,内镜直视下了解咽喉部及气道情况,避免误诊和漏诊。Objective To investigate the significance of flexible bronchoscopy in children with respiratory diseases.Methods A retrospective analysis was performed for the clinical data of 80 children who were hospitalized due to respiratory diseases（including severe pneumonia,Mycoplasma pneumoniae pneumonia with atelectasis/lung consolidation/local emphysema,protracted pneumonia,coughing and wheezing of unknown cause,chronic cough of unknown cause,and laryngeal stridor） and who underwent flexible bronchoscopy/alveolar lavage.Results Bronchoscopy found that all the 80 children had endobronchial inflammation,among whom 28 children had severe airway obstruction by secretion.Twenty-four children had congenital airway dysplasia besides endobronchial inflammation,and three children had bronchial foreign bodies.In the children with coughing and wheezing of unknown cause and laryngeal stridor,some had congenital airway dysplasia or bronchial foreign bodies.Among the 27 children with Mycoplasma pneumoniae pneumonia,26 had severe airway obstruction/embolization by secretion;25 children（93%） underwent chest imaging again at 2 weeks after alveolar lavage,and the results showed complete or partial lung recruitment.Among the 80 children who underwent bronchoscopy,3 had severe hypoxemia during surgery,1 had epistaxis,1 had minor bleeding during alveolar lavage,3 had transient bronchospasm,and 5 had postoperative fever;these children were all improved after symptomatic treatment.Conclusions Flexible bronchoscopy is safe and reliable in children with respiratory diseases.Early alveolar lavage under a flexible bronchoscope is recommended for children with severe/refractory Mycoplasma pneumoniae pneumonia to improve prognosis.Flexible bronchoscopy is recommended for children with recurrent coughing and wheezing and persistent laryngeal stridor,in order to directly observe the throat and airway under an endoscope.

关 键 词：软式支气管镜 诊断 安全性 儿童 

分 类 号：R725.6[医药卫生—儿科]