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目的探讨纤维支气管镜(纤支镜)术在小儿慢性咳嗽诊断及治疗中的价值。方法对2006年8月-2011年3月在本院应用纤支镜进行检查和(或)治疗的61例慢性咳嗽患儿的临床资料进行回顾性分析。病例均采用局部麻醉的方法,而且患儿均经临床程序排除咳嗽变异性哮喘和胃食管反流。通过镜下直视、支气管刷检及肺泡灌洗液,明确病因诊断;应用支气管肺泡灌洗、局部注药和钳取异物进行治疗,并对疗效做出评价。结果 61例患儿中男36例,女25例;年龄8个月～13岁。61例患儿镜下炎性改变21例(34.5%),先天性心肺发育畸形12例(19.7%),支气管异物10例(16.4%),上呼吸道咳嗽综合征8例(13.1%),支气管内膜结核7例(11.5%),未见异常3例(4.9%)。气管黏膜刷检涂片找到革兰阳性细菌和(或)革兰阴性细菌12例(12/31例,38.7%),肺泡灌洗液细菌培养阳性5例(5/40例,12.5%),未找到抗酸杆菌和癌细胞。对镜下炎性改变重、有痰栓阻塞者经纤支镜行支气管灌洗治疗,取得较好疗效。10例支气管异物经纤支镜成功取出8例。结论小儿慢性咳嗽经纤支镜检查发现以炎症及支呼吸管异物多见,婴幼儿期慢性咳嗽应警惕心肺发育异常及呼吸道异物。纤支镜检查对儿童慢性咳嗽的病因诊断与治疗具有重要价值,尤其对先天性心肺发育畸形及支气管细小异物的诊断有独特价值。
Objective To investigate the value of bronchofiberscopy in the diagnosis and treatment of chronic cough in children. Methods The clinical data of 61 children with chronic cough diagnosed and / or treated with fiberoptic bronchoscopy in our hospital from August 2006 to March 2011 were analyzed retrospectively. All cases were treated with local anesthesia, and children were clinically excluded from cough variant asthma and gastroesophageal reflux. Through the microscope, direct bronchial brushing and bronchoalveolar lavage fluid, a clear etiological diagnosis; the application of bronchoalveolar lavage, local injection and foreign body forceps were treated, and to evaluate the efficacy. Results 61 cases of children in 36 males and 25 females; aged 8 months to 13 years. 21 cases (34.5%) had concomitant inflammatory changes under microscope, 12 cases (19.7%) had congenital cardiopulmonary dysplasia, 10 cases (16.4%) had bronchial foreign bodies, 8 cases (13.1%) had upper respiratory tract cough syndrome, bronchus Intimal nodules in 7 cases (11.5%), no abnormalities in 3 cases (4.9%). Twelve cases (12/31 cases, 38.7%) of Gram-positive bacteria and / or Gram-negative bacteria were found in tracheal mucosal brushing smear. Five cases (5/40 cases, 12.5%) of bronchoalveolar lavage bacterial cultures were positive, No acid-fast bacilli and cancer cells were found. Of the inflammatory changes in the microscope, with sputum clogging by bronchoscopy bronchial lavage treatment, and achieved good results. 10 cases of bronchial foreign bodies were successfully removed by fiberoptic bronchoscopy in 8 cases. Conclusion Children with chronic cough by fiberoptic bronchoscopy found that inflammation and bronchial foreign body more common, infants and young children with chronic cough and heart and lung development should be alert to abnormalities and respiratory foreign body. Fiberoptic bronchoscopy for the diagnosis and treatment of children with chronic cough has important value, especially for congenital cardiopulmonary deformities and the diagnosis of bronchial foreign body has a unique value.