!堕压』b蛀盘圭2迦§生墨型鲞整!塑·31·论著·小儿纤维支气管镜检查与治疗的安全性探讨浙江大学医学院附属儿童医院呼吸科(浙江杭州310003)陈志敏刘金玲王财富【摘要】目的探讨小儿纤维支气管镜(纤支镜)检查与治疗的并发症,及其发生率和影响因素。方法对335例患儿进行纤吏镜术中和沭后24h并发症进行观察。结果335例行纤支镜术的患儿中共有141例(421%)出现术中或术后并发症,均为一过性。0~1岁、~3岁、~7岁和~14岁组并发症的发生率分别为51.5%、41.9%、37.7%和13,O%,后者明显低于其他各组。术中并发症以紫绀最常见,以婴儿组最高,随年龄增大而降低;术后并发症则以咳嗽或咳嗽加重最常见,气喘或气喘加重均发生于婴儿。支气管肺泡灌洗(BAL)患儿术后并发症为15.0%,高于未进行BAL患儿(9.5%),但无统计学差异。喉或气管支气管软化患儿术中或术后并发症50.0%,未软化的患儿28.0%,统计差异显著。结论儿科纤支镜术安全可靠,虽有~定的并发症,但大多轻微。婴儿及喉一气管支气管软化是并发症发生的高危因素。【关键词】儿童;纤维支气管镜;并发症【中图分类号】R725【文献标识码】A【文献标识码】1000一3606(2006】01一031—03SafetyofpediatricfiberopticbronehoseopyCHEW{仇i-mi",L,UJt%一0i竹,矸ⅫGCh纠乱.De·mrtm蛐t可凡fmo¨o!o删,G眦d他"’sH0sm缸f,办可i“叼咖泐惜锄Sc九oo!吖。胁dic诹e,踟巧io他g,胁%oz危ou3I∞03.(地ttonAbstract:Objec“veToobservethecomplicationratesduringandafterpedlatricfiberopticbron—choscopy(FOB)anditsriskfactors.MethodsThreehundredandthirty{ivecaseswereobservedforcomplicatjonsduringand24hoursafterFOB.ResultsSometransientandmildcomplicationswereob.servedin141cases(421%)duringand24hoursafterFOB.Thecomplicationrateswere515%,41.9%,37.7%and130%inchildrenyoungerthanlyear,~3year,~7yearand~14year—01d,respectively,withmuch10werrateineldestgroupthanthatoftheothergroups.CyanosiswasmostfrequentlyseenduringFOB.Thepeakra把happenedininfancyanddecreasedwithincreasingage.Themostfrequelltcomplicationwithin24hoursafterFOBwascoughorexacerbatedcough.Wheezingorexacerbatedwheezingwithin24hoursafterFOBonlyoccurredininfancy.Fifteenpercentofchildrenwlthbronchoalveolarlavage(BALJhadcomplicationsascomparedto95%inchildrennotreceivedBAL,ShowingnostatisticalsignificanceHalfofchildrenwithJaryn只ealortracheal_bronchialmalaciahadcomplicatioⅡsascomparedwith船0%inchildrenwithoutmalacia,showingstatisticalsignificanceConclusionsPediatricFOBisrelatively8afeandreIiabIe1nspiteofitshighbutmildcomplications.Youngagearldlaryngealortracheal‘bronchialmalaciaarehigh—riskfactorsforcomplications.Keywords:child;fiberopticbroⅡchoscopy;cOmplication小儿纤维支气管镜(纤支镜)的应用首次报道于1978年“1,实践已证明纤支镜在儿科呼吸系统疾病诊疗方面起着重要作用,但其潜在的危险性及并发症制约着小儿纤支镜术的普遍开展。为此,我们于2004年1月~2005年1月对335例患儿进行了纤支镜术中和术后并发症的观察,现报告如下。资料与方法一、资料本组患儿纤支镜主要适应证有:不明原因肺气肿或肺不张、喘鸣、声嘶、慢性咳嗽、胸通讯作者:陈志敏Email:zmchen@zju.edu.cn片异常、难治性肺炎、气管切开患儿的气道评估和咯血等”】。共335例,男196例,女139例;年龄5d~14岁,其中o~1岁103例(包括5d与9d2例新生儿),~3岁148例,~7岁61例,~14岁23例;病程o.5h~8年。术后诊为支气管异物151例,支气管炎、肺炎141例,喉或气管支气管软化24例,支气管狭窄18例,支气管扩张8例,支气管畸形3例,肺含铁血黄素沉着症2例,肺囊肿3例,肺血管畸形伴咯血1例等。二、方法患儿均在镇静+局部麻醉下完成纤支镜检查。术前肌注安定及阿托品⋯,2%利多卡因用于咽喉部及气管内麻醉。根据患儿年龄体重选万方数据·32·用不同...