CAJ | 학술논문

目的：评估纤维支气管镜和肺泡灌洗术治疗在 PICU 重症肺部感染的诊断、治疗价值及安全性。方法回顾性分析我院 PICU 2012年3月至2014年2月收治的263例重症肺部感染患儿327例次纤维支气管镜检查资料,并收集同期108例家属不同意行纤维支气管镜检查肺部感染患儿为对照组,比较肺泡灌洗术治疗后与对照组的临床表现、实验室资料情况。结果(1)肺泡灌洗液培养主要菌谱以革兰阴性菌为主,支气管肺泡灌洗液培养阳性率53.99%(142/263)。(2)炎症病变为反复难治性肺炎或肺不张的首要病因[93.90%(231/246)]；伴气道发育异常90.24%(222/246),其中气管支气管软化占76.58%(170/222)。不同年龄段患儿气道原发病变不同,差异有统计学意义(χ2﹦25.886, P ﹦0.000)。(3)先天性心脏病合并肺动脉高压患儿气管支气管软化发生率(94.19%)较无肺动脉高压患儿(38.09%)明显增高(P 〈0.05)。(4)与对照组相比,经纤维支气管镜行肺泡灌洗治疗后患儿发热、咳嗽、喘息、肺部啰音及肺不张等临床症状明显缓解,感染指标 C 反应蛋白、降钙素原明显降低,PaO2、氧合指数(P/F)及 SaO2升高,差异均有统计学意义(P 均〈0.05)。结论纤维支气管镜术和支气管肺泡灌洗术对重症肺部感染尤其是难治性肺炎或肺不张患儿有着重要作用,可直接清除肺内痰液分泌物,保持气道通畅,缩短病程,是诊断气道发育异常及支气管异物的有效手段,并且安全有效。
목적：평고섬유지기관경화폐포관세술치료재 PICU 중증폐부감염적진단、치료개치급안전성。방법회고성분석아원 PICU 2012년3월지2014년2월수치적263례중증폐부감염환인327례차섬유지기관경검사자료,병수집동기108례가속불동의행섬유지기관경검사폐부감염환인위대조조,비교폐포관세술치료후여대조조적림상표현、실험실자료정황。결과(1)폐포관세액배양주요균보이혁란음성균위주,지기관폐포관세액배양양성솔53.99%(142/263)。(2)염증병변위반복난치성폐염혹폐불장적수요병인[93.90%(231/246)]；반기도발육이상90.24%(222/246),기중기관지기관연화점76.58%(170/222)。불동년령단환인기도원발병변불동,차이유통계학의의(χ2﹦25.886, P ﹦0.000)。(3)선천성심장병합병폐동맥고압환인기관지기관연화발생솔(94.19%)교무폐동맥고압환인(38.09%)명현증고(P 〈0.05)。(4)여대조조상비,경섬유지기관경행폐포관세치료후환인발열、해수、천식、폐부라음급폐불장등림상증상명현완해,감염지표 C 반응단백、강개소원명현강저,PaO2、양합지수(P/F)급 SaO2승고,차이균유통계학의의(P 균〈0.05)。결론섬유지기관경술화지기관폐포관세술대중증폐부감염우기시난치성폐염혹폐불장환인유착중요작용,가직접청제폐내담액분비물,보지기도통창,축단병정,시진단기도발육이상급지기관이물적유효수단,병차안전유효。
Objective To assess the diagnosis,therapeutic value and safety of the fiberoptic bron-choscope and alveolar lavage treatment on severe lung infection in PICU.Methods A total of 263 cases of severe lung infection that admitted to the PICU of Hu'nan Children's Hospital during March 1 st,2012 to Feb-ruary 28th,2014 were retrospectively selected as bronchoscope treatment group,which underwent 327 times of bronchoscopy treatment.We also collected 108 children with lung infection whose family disagreed with fi-beroptic bronchoscope treatment in the same period as the control group.Clinical manifestations and results of laboratory tests were compared between the bronchoscope treatment group and the control group.Results (1 )Gram-negative bacterium was the mainly bacterial spectrum in bronchoalveolar lavage fluid of broncho-scope treatment group,and the culture-positive rate was 53.99%(142/263).(2)The mainly cause of repeated or refractory pneumonia or atelectasis was inflammation infection,accounting for 93.90%(231 /246),the rate of airway abnormalities was 90.24%(222 /246)when tracheobronchomalacia accounting for 76.58%(170 /222).The primary lesions of airway were different significantly among different age groups(χ2 ﹦25.886, P ﹦0.000).(3)The rate of tracheobronchomalacia in cases of congenital heart disease with pulmonary hy-pertension was 94.19%,which was significantly higher than those without pulmonary hypertension (38.09%)(P 〈0.05).(4)None serious complications happened to the children of bronchoscope treatment group.The clinical symptoms of fever,cough,breathing,pulmonary tribal sounds and atelectasis were relieved in bronchoscope treatment group compared with the control group.The inflammation indicators as C-reactive protein and procalcitonin decreased significantly in bronchoscope treatment group than those of control group (P 〈0.05 ),while PaO2 ,oxygenation index and SaO2 increased(P 〈0.05 ).Conclusion Fiberoptic bron-choscope and alveolar lavage treatment plays an important role on severe pulmonary infection,especially on refractory pneumonia or atelectasis.It not only can directly remove the sputum secretion in lung which could keep the airway unobstructed and shorten the course of diseases,but also can be an effective diagnostic means of airway dysplasia and foreign body in bronchus,and fiberoptic bronchoscope is safe and effective in PICU.