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目的探讨纤维支气管镜(纤支镜)术对小儿反复喘息性疾病的诊断及治疗价值。方法收集本院2006年4月-2011年4月因反复喘息住院并应用纤支镜诊疗的72例患儿的临床资料。病例均在局部表面麻醉下行纤支镜术,通过镜下直视、支气管内膜刷检、支气管肺泡灌洗液病原学检查进一步明确病因,行支气管肺泡灌洗及注药等局部治疗,并评判其疗效和并发症发生情况。结果 72例反复喘息患儿镜下表现:支气管内膜炎改变45例(62.5%),支气管异物11例(15.3%),支气管软化10例(13.9%),支气管狭窄4例(5.6%),支气管内膜结核2例(2.8%)。45例患儿支气管肺泡灌洗液病原学检查阳性5例(11.1%),其中肺炎克雷伯杆菌1例,肺炎支原体和支气管内膜结核各2例。镜下炎症改变重、分泌物黏稠、痰栓阻塞患儿经纤支镜支气管冲洗,咳喘明显减轻,取得较好疗效。11例支气管异物经纤支镜成功取出9例。12例行纤支镜术的患儿出现术中或术后轻微一过性并发症,经相应对症处理后均消失。结论小儿反复喘息的病因以炎症、先天性发育异常及呼吸道异物多见,婴幼儿反复喘息应警惕心肺发育异常及呼吸道异物。纤支镜检查对儿童反复喘息的病因诊断具有重要价值。
Objective To investigate the diagnostic and therapeutic value of bronchoscopy (bronchofibroscopy) for recurrent wheezing in children. Methods The clinical data of 72 children admitted to our hospital from April 2006 to April 2011 due to repeated wheezing and bronchofibroscopy were collected. The cases underwent local surface anesthesia under fiberoptic bronchoscopy, through the microscope, endoscopic brush examination, bronchoalveolar lavage etiology to further clarify the cause, bronchoalveolar lavage and injection and other local treatment, and judged Its efficacy and complications. Results 72 cases of recurrent asthmatic children underwent microscopic findings: bronchial intima change in 45 cases (62.5%), bronchial foreign body in 11 cases (15.3%), bronchial softening in 10 cases (13.9%) and bronchial stenosis in 4 cases (5.6% Bronchial tuberculosis in 2 cases (2.8%). Among the 45 children, bronchial alveolar lavage etiology was positive in 5 cases (11.1%), including 1 Klebsiella pneumoniae, 2 mycoplasma pneumoniae and 2 bronchial invaders. Microscopic inflammation changed heavy, secretions viscous, sputum clot bronchial obstruction in children with bronchial washes, cough and asthma significantly reduced, and achieved good results. Eleven cases of bronchial foreign bodies were successfully removed by fiberoptic bronchoscopy in 9 cases. 12 cases of patients with fiberoptic bronchoscopy occurred during surgery or postoperative minor transient complications, after the corresponding symptomatic treatment were disappeared. Conclusions The cause of recurrent wheezing in infants is more common with inflammation, congenital dysplasia and airway foreign bodies. Infants with repeated wheezing should be alert to cardio-pulmonary dysplasia and respiratory foreign bodies. Fiberoptic bronchoscopy for the diagnosis of etiology in children with repeated wheezing is of great value.