189例儿童局限性肺不张病因分析及治疗转归

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摘要目的探讨儿童局限性肺不张的病因诊断及纤维支气管镜(纤支镜)镜下治疗对病变部位复张的治疗效果。方法经肺部影像学证实为局限性肺不张的226例住院病人,分为纤支镜诊治组(189例)和对照组(37例)。对纤支镜诊治组患儿临床资料及纤支镜检查结果予以分析,并与对照组病例资料进行比较分析。结果纤支镜诊治组189例患儿共行222例次纤支镜诊治术,结果显示全部病例均有支气管粘膜炎性病变,73例病变部位粘液痰栓形成,21例患儿不同程度气管或支气管软化,11例支气管开口异常或管腔狭窄,9例气管支气管异物,3例支气管内新生肉芽形成,2例气管源性支气管,1例气管前壁血管瘤。出院时纤支镜诊治组患儿肺部局限性病变完全复张、部分复张、无明显改善例数分别为146例、27例和7例,而对照组分别为17例、14例、6例,两组比较差异有统计学意义(P<0.05)。纤支镜诊治组平均住院日(12.1±0.2) d,较对照组平均住院时间(16.2±0.4) d短,且差异具有统计学意义(P<0.05)。纤支镜诊治组未出现呼吸心跳骤停或血流动力学改变等不良事件。结论纤支镜术能够明确肺不张病因,促进病变部位复张,缩短平均住院时间,经济且安全性好。

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关键词 ：儿童, 肺不张, 纤维支气管镜

Abstract：Objective To explore the value of flexible fiberoptic bronchoscopy in the diagnosis and treatment of pulmonary atelectasis in children.Methods A total of 226 hospitalized children with localized atelectasis confirmed by X-ray or pulmonary CT were divided into bronchoscopy group (n=189) and control group (n=37). The results of fiberoptic bronchoscopy group were compared with control group.Results In bronchoscopy group(189 patients), flexible fiberoptic bronchoscopy was performed 222 times. Bronchial mucosal inflammatory changes were found in all the 189 cases, mucous sputum formation in 73 cases, tracheal or bronchial softening in 21 cases, bronchial stenosis or abnormal opening in 11 cases, tracheobronchial foreign body in 9 cases, bronchial neoplasia in 3 cases, tracheal bronchus in 2 cases, and anterior tracheal hemangioma in 1 case . During their stay in hospital, all the cases underwent lavages in the bronchoscopy group, which showed that the lesion had completely expanded in 146 cases, partially expanded in 27 cases, and remained unchanged in 7 cases,compared with 17 cases, 14 cases and 6 cases respectively in control group. There was significant difference between the two groups. The average length of hospital stay was(12.1?.2)days in bronchoscopy group and(16.2?.4)days in control group, respectively. There was significant difference between the two groups. There was not any respiratory arrest or hemodynamic changes in bronchoscopy groups.Conclusion Fibrobronchoscopy can help identify the cause of atelectasis, promote the reexpansion of the lesion, shorten the average length of hospital stay, and ensure safety.

Key words： Children atelectasis flexible fiberoptic bronchoscopy

收稿日期: 2016-10-21 出版日期: 2017-01-05

基金资助:国家自然基金面上项目(No.81472018)

通讯作者: zhouhq2005@qq.com

引用本文:

周浩泉, 代传林, 陶松雪, 王雪松, 李庆, 潘家华. 189例儿童局限性肺不张病因分析及治疗转归[J]. 解放军预防医学杂志, 2016, 34(6): 899-901.
ZHOU Haoquan, DAI Chuanlin, TAO Songxue, WANG Xuesong, LI Qing, PAN Jiahua. Analysis of Etiology of 189 Children with Local Pulmonary Atelectasis and Treatment Outcome. Journal of Preventive Medicine of Chinese People's Liberation Army, 2016, 34(6): 899-901.

链接本文:

http://manu37.magtech.com.cn/Jwk_jsyxkx/jfj/CN/ 或 http://manu37.magtech.com.cn/Jwk_jsyxkx/jfj/CN/Y2016/V34/I6/899

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