摘要
目的探讨支气管镜检查术在小儿呼吸系统疾病中的诊治作用及安全性。方法回顾分析了136例患儿共145例次的支气管镜检查结果,其中硬质支气管镜检查120例次,纤维支气管镜检查25例次,22例同时行局部冲洗或肺泡灌洗;全部病例均采用异丙酚为主的静脉复合麻醉。结果术前怀疑异物吸入112例中,经支气管镜检查,发现异物91例,分泌物阻塞(痰栓)15例,肉芽肿3例,右主支气管乳头状瘤、气管憩室并左主支气管狭窄、声门下气管狭窄各1例。经取出异物,或吸除分泌物及肉芽后,109例患儿痊愈。反复或持续肺炎22例经纤维支气管镜检查及局部冲洗或肺泡灌洗,17例治愈,3例好转:1例确诊为特发性肺含铁血黄素沉着症经治疗后好转,1例右上肺实变仍诊断不明,1例局部灌洗用药后好转。136例患儿经检查及治疗,确诊率为98.53%(134/136),治愈率92.65%(126/136),好转率3.68%(5/136)。145例次支气管镜检查过程中,2例并发双侧气胸、纵隔气肿及皮下气肿;2例因声门下异物过大行气管切开后取出;1例出现喉痉挛;1例因缺氧发作终止操作。全部患儿无呼吸抑制、低血压、心律失常、出血及死亡。结论支气管镜检查是小儿呼吸系统疾病很好的诊断及治疗手段之一,在以异丙酚为主的静脉复合麻醉下进行检查,安全、不良反应少。
Objective To evaluate the diagnostic and therapeutic value of bronchoscopy in the children with respiratory diseases.Methods Retrospective analysis was made of 145 bronchoscopy procedures in 136 children,120 of 145 procedures performed by rigid bronchoscopy, 25 of 145 procedures performed by fiber-bronchoscopy, 22 patients received bronchoalveolar lavage.Results Among 112 patients suspected foreign body aspiration,91 had foreign body,15 had secretion obstruction,3 had granuloma,1 had right bronchial papilloma,1 had tracheal diverticulum and left bronchostenosis,1 had hypolarynx tracheostenosis.After extracted foreign body or granuloma,109 had cured,the other 3 had not received treatment.Among 22 patients with recurrent or persistent pneumonia, 20 were cured or improved, 1 was diagnosed as pulmonary hemosiderosis,1 was not diagnosed.1 patient with hemoptysis was found the lesions in trachea.1 patient with bronchiect and infection was improved after two fiberoptic bronchoscopy BAL and infuse of amikacin.Among 136 patients,the final diagnosis rate was 98.53%, cure rate was 92.65%, improvement rate was 3.68%.During the 145 procedures, 2 had pneumothorax、mediastial emphysema and pneumoderma, 2 received tracheotomy because big foreign body in hypolarynx, 1 had laryngospasm, and one hypoxemic spells.No patients had breath inhibition,hypertension,bleeding and death.Conclusion The bronchoscopy is an effective method for diagnosis and treatment of respiratory diseases in children.The bronchoscopy procedures in balanced anesthesia with propofol is safe.
出处
《小儿急救医学》
2005年第3期188-190,共3页
Pediatric Emergency Medicine
