CAJ | 학술논문

目的探讨纤维支气管镜(bronchofibroscope,BFS)在PICU中临床应用的价值及安全性.方法对我院PICU中79例危重患儿进行89例次BFS检查操作,分析PICU接受BFS操作患儿的病因,对接受BFS操作前后患儿的血气及氧合指数进行对比分析,观察BFS操作的并发症;对其中40例次机械通气同时接受支气管肺泡灌洗治疗的患儿进行呼吸力学指标的分析;同时对74例次支气管肺泡灌洗液培养结果进行分析总结.结果在PICU接受BFS操作的原发疾病仍以呼吸系统疾病为主(64/79),接受BFS操作前后患儿氧合指数、血pH值无显著变化(P＞0.05),无心跳骤停、气胸等严重并发症发生,轻微并发症中以一过性SpO2下降最为常见(15/79).支气管肺泡灌洗后,机械通气患儿的气道阻力有显著下降(P＜0.05),但动态肺顺应性及呼吸功无明显变化(P＞0.05);支气管肺泡灌洗液培养阳性率为29.1%(23/79),其中以革兰阴性菌为主,符合PICU常见致病菌谱.结论 PICU应用BFS可提高危重患儿的抢救及气道管理水平,严格掌握检查指征,在PICU监护下进行BFS诊疗是安全的.
목적 탐토섬유지기관경(bronchofibroscope,BFS)재PICU중림상응용적개치급안전성.방법 대아원PICU중79례위중환인진행89례차BFS검사조작,분석PICU접수BFS조작환인적병인,대접수BFS조작전후환인적혈기급양합지수진행대비분석,관찰BFS조작적병발증;대기중40례차궤계통기동시접수지기관폐포관세치료적환인진행호흡역학지표적분석;동시대74례차지기관폐포관세액배양결과진행분석총결.결과 재PICU접수BFS조작적원발질병잉이호흡계통질병위주(64/79),접수BFS조작전후환인양합지수、혈pH치무현저변화(P＞0.05),무심도취정、기흉등엄중병발증발생,경미병발증중이일과성SpO2하강최위상견(15/79).지기관폐포관세후,궤계통기환인적기도조력유현저하강(P＜0.05),단동태폐순응성급호흡공무명현변화(P＞0.05);지기관폐포관세액배양양성솔위29.1%(23/79),기중이혁란음성균위주,부합PICU상견치병균보.결론 PICU응용BFS가제고위중환인적창구급기도관리수평,엄격장악검사지정,재PICU감호하진행BFS진료시안전적.
Objective To explore the efficacy and safety of clinical application of bronchofibroscope (BFS) in PICU. Methods Seventy-nine critically ill children in our PICU were operated with BFS in 89 cases and the etiology of these children was analyzed. The blood-gas analysis and oxygenation index both before and after the treatment had been compared, and syndrome was observed as well. For 40 cases in which critically ill children received bronchoalveolar lavage in addition to mechanical ventilation, and the index of respiratory mechanics was analyzed. Analysis and summary had been performed on the culture results of bronchoalveolar lavage fluid in 74 cases. Results The primary disease in these cases was mainly respiratory diseases (64/79). There was no major change in oxygenation index and blood pH ( P ＞0. 05 ) before and after operation with BFS. No severe syndrome,such as sudden cardiac arrest and pneumothorax, was recorded. However,transient decrease in SpO2 was most frequently observed in minor syndromes (15/79). The children treated with mechanical ventilation were recorded with significant decrease in air way resistance ( P ＜ 0. 05 ) after bronchoalveolar lavage. However,dynamic compliance and work of breathing only changed slightly (P ＞0. 05 ). The culture positive rate of bronchoalveolar lavage fluid was 29. 1% (23/79) ,mainly gram-negative bacteria, which coincided with disease spectrum of PICU. Conclusion The application of BFS in PICU can improve salve and tracheobronchial management for critically ill children. The diagnosis and treatment is safe and reliable by strictly grasping the examination indication by BFS under the custody of PICU.