软式支气管镜在儿童呼吸系统疾病中的应用

发布时间：2018-06-12 19:26

本文选题：软式支气管镜 + 诊断　；参考：《中国当代儿科杂志》2017年11期

【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。
[Abstract]:Objective to evaluate the clinical value of soft bronchoscopy in children with respiratory diseases. Methods 80 cases of respiratory diseases (including severe pneumonia, mycoplasma pneumoniae pneumonia with atelectasis / pulmonary consolidation / localized emphysema, persistent pneumonia, cause of cough and chronic cough) were studied. The clinical data of children undergoing soft bronchoscopy / alveolar lavage were retrospectively analyzed. Results bronchial endobronchial inflammation was found in 80 children, including 28 cases with severe secretion. On the basis of endobronchial inflammation, 24 cases were complicated with congenital airway dysplasia, and 3 cases were found foreign bodies in the bronchus. There were 27 cases of mycoplasma pneumoniae pneumonia in some of the children with congenital abnormal airway development or foreign body of bronchus, among the children whose causes of cough and asthma were unknown and larynx wheezing. The chest imaging reexamined 2 weeks after alveolar lavage showed that the lungs were completely or mostly enlarged. Among the 80 children who underwent bronchoscopy, severe hypoxemia occurred in 3 cases, epistaxis in 1 case, small amount of hemorrhage in alveolar lavage in 1 case, bronchial spasm in 3 cases, fever in 5 cases after operation. Conclusion soft bronchoscopy is safe and reliable in children with respiratory diseases. Patients with severe / refractory mycoplasma pneumoniae pneumonia should be treated with soft bronchoscope alveolar lavage early to improve prognosis. Children with recurrent cough and persistent laryngeal wheezing should be examined with soft bronchoscopy, and the pharyngopharynx and airway should be understood under endoscope, so as to avoid misdiagnosis and missed diagnosis.
【作者单位】：贵州省人民医院儿科;
【分类号】：R725.6

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