儿童肺不张支气管镜检和病原学分析  

Analysis of airway abnormality by bronchoscopy and pathogens in child atelectasis

作　　者：谢晓虹[1] 王崇杰[1] 刘玉琳[1] 唐方芳[1] 张湛美 罗征秀[1] 刘恩梅[1] 罗健[1] 

机构地区：[1]重庆医科大学附属儿童医院礼嘉呼吸科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室,重庆400014

出　　处：《重庆医科大学学报》2017年第12期1681-1684,共4页Journal of Chongqing Medical University

基　　金：国家临床重点专科建设资助项目(编号:2011-873)

摘　　要：目的:探讨肺不张儿童支气管镜下病变、支气管肺泡灌洗液病原学及两者之间的关系。方法:回顾性分析重庆医科大学附属儿童医院呼吸中心2011年12月至2016年6月确诊肺不张并行支气管镜检查患儿共412例,通过Chi-square with Yates'correction检验和Fisher精确检验比较不同部位肺不张镜下异常和检出病原的差异。结果:(1)肺不张前两位是右中叶不张(41.0%,169/412)和右上叶(40.7%,168/412),前者在>3岁组检出率明显增高(115/223 vs.54/189,P=0.000),后者在≤3岁组检出率明显增高(110/189 vs.58/223,P=0.000)。支气管镜检异常155例,前三位为支气管狭窄85例(54.8%)、化脓性内膜炎45例(29.0%)、黏液栓21例(13.5%)。(2)支气管肺泡灌洗液病原检出240例(58.2%),其中细菌141例(34.2%)和肺炎支原体126例(30.5%)。鼻咽抽吸物病毒检出74例(18.0%)。(3)右中叶病变化脓性内膜炎32例(18.9%),化脓性内膜炎组肺炎链球菌检出较非化脓组明显增高(13/32 vs.24/137,P=0.009)。右上叶狭窄52例(31.0%),狭窄组肠杆菌科细菌检出率(15/52 vs.15/116,P=0.023)和早产儿率(16/52 vs.18/116,P=0.039)较非狭窄组明显增高。黏液栓组肺炎支原体检出率明显高于非黏液栓组(11/21vs.115/391,P=0.047)。结论:儿童肺不张部位与年龄有关。肺不张受累叶或段支气管可存在狭窄、化脓性内膜炎和黏液栓等病变,狭窄和化脓性内膜炎与细菌有关,黏液栓与肺炎支原体有关。Objective：To investigate airway abnormalities at flexible bronchoscopy and bronchoalveolar lavage fluid（BALF）pathogen profile in children of pulmonary atelectasis.Methods：Totally 412 pulmonary atelectasis cases with bronchoscopy performance in respiratory disease center of Children＇s Hospital of Chongqing Medical University from December 2011 to June 2016 were analyzed retrospectively.Data of bronchoscopy abnormality and BALF pathogens were analyzed by Chi-square with Yates＇ correction test and Fisher＇s exact test.Results：（1）The common atelectasis was in the right middle lobe（41.0%,169/412）and right upper lobe（40.7%,168/412）,and the former was found higher in 3 years group（115/223 vs.54/189,P=0.000）,the latter was found higher mainly in ≤3 years group（110/189 vs.58/223,P=0.000）.Airway abnormalities were observed in 155 cases including 85 cases（54.8%）of bronchial stenosis,45 cases（29.1%）of bronchial suppurative inflammation and 21 cases（13.5%）of mucus plug.（2）240 BALF samples（58.2%）were detected positive for pathogens including 141（34.2%）samples positive of bacterial and 126（30.5%）samples positive of mycoplasma.74 nasopharyngeal aspiration（NPA）samples（18.0%）were detected positive for respiratory viruses.（3）Bronchial suppurative inflammation were found in 32 cases（18.9%）of right middle lobe atelectasis,in which positive rate of S.Pneumoniae was higher than that of patients without suppurative inflammation（13/32 vs.24/137,P=0.009）.Bronchial stenosis were found in 52 case（31.0%）of right upper lobe atelectasis,in which positive rate of enterobaeteriaceae（15/52 vs.15/116,P=0.023）and rate of preterm birth（16/52 vs.18/116,P=0.039）were higher than that of patients without stenosis.Positive rate of mycoplasma in cases of mucus plug was higher than cases without mucus plug（11/21 vs.115/391,P=0.047）.Conclusion：Atelectasis location is related to the age of children.Airway abnormalities as bronchial stenosis,bronchial suppur

关 键 词：肺不张 儿童 支气管镜检查术 支气管肺泡灌洗液 

分 类 号：R725.6[医药卫生—儿科]