电子支气管镜在新生儿反复呼吸困难疾病中的应用  

The clinical application of electronic bronchoscope in newborns with recurrent dyspnea

作　　者：黄冬平[1] 黄苑铭[1] 谢丹宇[1] 李敏敏[1] 黎静[1] 唐远平[1] 彭淑梅[1] 陈运彬[1] Huang Dongping;Huang Yuanming;Xie Danyu;Li Minmin;Li Jing;Tang Yuanping;Peng Shumei;Chen Yunbin(Pediatrics,Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院儿科,广州510010

出　　处：《中华新生儿科杂志（中英文）》2018年第4期250-253,共4页Chinese Journal of Neonatology

基　　金：广东省科技厅科技计划项目（2016ZC0187）

摘　　要：目的探讨电子支气管镜在新生儿反复呼吸困难疾病诊断及治疗中的应用价值。方法回顾性选取2014年10月至2017年10月在本院新生儿重症监护病房应用电子支气管镜检查并诊断的反复呼吸困难新生儿临床资料，对患儿临床特点及治疗效果进行总结分析。结果共纳入171例反复呼吸困难新生儿，经电子支气管镜检查明确病因前4位为气管支气管内膜炎78例（45.6%），喉软骨软化症和气管支气管软化症22例（12.9%），气道狭窄14例（8.2%），气管食管瘘12例（7.0%）。术中及术后并发症主要为经皮血氧饱和度和（或）心率下降（20.5%，35/171）、黏膜出血（12.3%，21/171）及支气管肺泡灌洗后发热（7.6%，13/171）。其中78例支气管内膜炎患儿均治愈；22例喉软骨软化症和气管支气管软化症及9例气道狭窄患儿经治疗后好转；1例声门下狭窄患儿行支气管镜下钬激光消融术后气道狭窄处明显扩大，随访未见气道狭窄再生。结论对于反复呼吸困难新生儿应查找病因，电子支气管镜可作为探查病因的重要手段之一，部分患儿可起到治疗作用且安全可靠。ObjectiveTo study the clinical value of electronic bronchoscope in diagnosis and treatment of recurrent dyspnea in neonates.MethodFrom October 2014 to October 2017, the clinical data of recurrent dyspnea receiving electronic bronchoscopy examination and treatment in the neonatal intensive care unit of our hospital were retrospectively selected. Their clinical characteristics and treatment effects were summarized and analyzed.ResultA total of 171 infants of neonatal recurrent respiratory infections were examined using electronic bronchoscope. The top four causes included endo-tracheo-bronchitis in 78 cases （45.6%）, laryngomalacia, and tracheobronchomalacia in 22 cases （12.9%）, airway stenosis in 14 cases （8.2%） and esophagotracheal fistula in 12 cases （7.0%）. The complications of intraoperative and postoperative included decline of percutaneous oxygen saturation and/or heart rate （20.5%, 35/171）, mucosal bleeding （12.3%, 21/171）, and fever after bronchoalveolar lavage. Electronic bronchoscopy examination confirmed all the 171 neonates′diagnosis and some of them recovered after corresponding treatment. 78 cases of infants with endo-tracheobronchitis were all cured. 22 cases of laryngomalacia and tracheobronchomalacia and nine patients with airway stenosis improved and were discharged after treatment. One patient with subglottic stenosis received bronchoscopic holmium laser ablation therapy and the airway significantly expanded. No re-stenosis was found during follow-up.ConclusionElectronic bronchoscopy is an important method to determine the cause of recurrent dyspnea in newborns, and it′safe, reliable and can play a therapeutic role in some neonates.

关 键 词：支气管镜检查 呼吸困难 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]