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目的探讨纤维支气管镜(FB)在小儿先天性心脏病(CHD)呼吸道病变诊疗中的应用价值。方法选取2006年7月-2010年5月在本院因难治性肺炎、肺不张、反复或持续性喘息、呼吸机依赖、CHD术前术后呼吸道病变评估等而住院的CHD患儿72例,应用O lympus BF-3C40镜,在常规局部浸润麻醉下进行FB检查,并对其中12例合并肺不张患儿进行支气管肺泡灌洗(BAL)治疗。结果镜下发现CHD患儿呼吸道病变以炎症及呼吸道阻塞性改变多见,分别占88.9%和72.2%。其中气管或支气管外压性狭窄46例,气管或支气管软化8例,喉软化5例,右侧气管源性支气管4例,血管环、气管下段及右主支气管先天性狭窄、左侧声带麻痹各1例;合并肺动脉高压(PH)者呼吸道外压性狭窄发生率(91.3%)较无PH者(19.2%)明显增高;对12例肺不张患儿行BAL治疗,治愈7例;术中31例(43.1%)出现一过性低氧血症,但无严重并发症发生。结论炎性反应和气管或支气管狭窄及软化是CHD患儿常见的呼吸道病变,PH是导致呼吸道外压性狭窄的重要因素,FB在小儿CHD呼吸道病变评估中不仅能发挥诊断作用,而且可发挥治疗作用,且相对安全。
Objective To investigate the value of fibrobronchoscopy (FB) in the diagnosis and treatment of children with congenital heart disease (CHD). Methods From July 2006 to May 2010 in our hospital for treatment of refractory pneumonia, atelectasis, recurrent or persistent wheezing, ventilator dependence, CHD preoperative and postoperative respiratory disease assessment of hospitalized children with CHD 72 For example, FB was performed under general local infiltration anesthesia using O lympus BF-3C40 and bronchoalveolar lavage (BAL) was performed in 12 of 12 children with atelectasis. Results The findings of pathological changes of respiratory tract in CHD children with inflammation and airway obstruction were more common, accounting for 88.9% and 72.2% respectively. 46 cases of tracheal or bronchial external pressure stenosis, tracheal or bronchial softening in 8 cases, laryngeal softening in 5 cases, right tracheobronchial bronchus in 4 cases, vascular ring, tracheal and right main bronchus congenital stenosis, left vocal cord paralysis 1). The incidence of airway pressure stenosis (91.3%) in patients with pulmonary hypertension (PH) was significantly higher than that in non-PH patients (19.2%). In 12 patients with atelectasis, BAL was cured in 7 patients. 31 cases (43.1%) had transient hypoxemia, but no serious complications occurred. Conclusion Inflammatory reaction and tracheal or bronchial stenosis and softening are common respiratory diseases in children with CHD. PH is an important factor leading to external pressure stenosis. FB can not only play a diagnostic role in the assessment of CHD in children, but also can treat Role, and relatively safe.