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目的探讨纤维支气管镜(纤支镜)术在小儿难治性肺炎诊治中的应用价值。方法选取2005年6月-2009年6月在本院住院经常规抗感染治疗2周以上仍无效的难治性肺炎62例。应用Olympus BF-3C30或BF-P40镜,在常规局部浸润麻醉下进行纤支镜检查和局部治疗。结果镜检结果:单纯性炎性改变27例(43%),异物吸入合并感染20例(32%),支气管内结核7例(11%),发育异常合并感染4例(6%),支气管扩张、肺含铁血黄素沉着症各2例(各3%)。其中发育异常合并感染均见于1岁内小婴儿,异物吸入合并感染多见于1～3岁婴幼儿,结核及支气管扩张多见于学龄期儿童。27例单纯性炎性病变患儿支气管灌洗液培养、支原体PCR检查及刷检涂片明确病原11例,病原检查阳性率为40%。对47例纤支镜下示炎症所致分泌物阻塞、狭窄的患儿予局部灌洗及注药治疗,取得满意效果;其中19例肺不张患儿经纤支镜治疗,2周内复张15例,复张率为79%。20例异物吸入患儿经纤支镜取出异物14例,治愈率70%。结论纤支镜在小儿难治性肺炎的病因诊断和治疗中有重要价值。
Objective To investigate the value of fiberoptic bronchoscopy in the diagnosis and treatment of children with refractory pneumonia. Methods Sixty-two patients with refractory pneumonia who were treated in our hospital from June 2005 to June 2009 after routine anti-infective therapy more than 2 weeks were still ineffective. Applications Olympus BF-3C30 or BF-P40 mirror, bronchoscopy and local treatment under conventional local infiltration anesthesia. RESULTS: The results of microscopic examination included 27 cases (43%) with simple inflammatory changes, 20 cases (32%) with inhalation of foreign body, 7 cases with endobronchial tuberculosis (11%), 4 cases with abnormal developmental infection (6% Expansion, pulmonary hemosiderosis in 2 cases (3% each). Incidence of developmental abnormalities were found in 1 year old infants infected with small intestine, foreign body infection and infection more common in infants 1-3 years old, tuberculosis and bronchiectasis more common in school-age children. 27 cases of simple inflammatory lesions in children with bronchial lavage culture, mycoplasma PCR and brushing smear clear pathogen in 11 cases, the positive rate of pathogen examination was 40%. 47 cases of bronchoscopic inflammation caused by secretions obstruction, stenosis in children with local lavage and injection drug treatment, and achieved satisfactory results; of which 19 cases of atelectasis in children treated with fiberoptic bronchoscopy, 2 weeks of complex Zhang 15 cases, recovery rate was 79%. Twenty patients with foreign bodies were removed by fiberoptic bronchoscopy in 14 cases, the cure rate was 70%. Conclusion Bronchofiberscopy is of great value in the diagnosis and treatment of pediatric refractory pneumonia.