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目的探讨和分析无痛纤维支气管镜术在诊治小儿呼吸道疾病中的应用价值。方法2003年1月至2005年1月,重庆医科大学附属儿童医院对原因不明的肺不张、反复或持续喘息、慢性咳嗽等小儿呼吸道疾病92例,男57例,女35例,年龄2个月至15岁,应用OlympusBF3c-20纤维支气管镜,在异丙酚无痛麻醉下进行病因检查和局部治疗。结果38例肺不张纤支镜术检查显示炎性狭窄、阻塞最多见,为18例(47.4%);经局部灌洗、给药治疗,2周内复张率高达76.3%(29/38)。25例反复或持续喘息患儿,纤支镜术显示炎症所致分泌物阻塞、狭窄14例,气管-支气管软化、狭窄9例,细小异物2例,经局部灌洗给药治疗,获得较满意效果。29例慢性咳嗽中4例为支气管异物,19例为慢性支气管内膜炎,其他6例。92例患儿均采用异丙酚无痛麻醉,术中氧饱和度在0.90以上。结论儿科开展无痛纤维支气管镜术对肺不张、反复或持续喘息性疾病、慢性咳嗽等的病因诊断与治疗十分重要,对支气管细小异物的诊断有独特价值。异丙酚无痛基础麻醉下进行纤维支气管镜检术,使得操作更加容易,减少了风险,增加了安全性。
Objective To investigate and analyze the value of painless fiberoptic bronchoscopy in the diagnosis and treatment of pediatric respiratory diseases. Methods From January 2003 to January 2005, 92 cases of pediatric respiratory diseases such as unexplained atelectasis, repeated or persistent wheezing and chronic cough were included in the Children’s Hospital of Chongqing Medical University from January 2003 to January 2005. There were 57 males and 35 females, aged 2 Months to 15 years old, the use of OlympusBF3c-20 fiberoptic bronchoscopy, analgesia under propofol etiology check and local treatment. Results 38 cases of pulmonary atelectasis showed inflammatory stenosis, the most common obstruction was 18 cases (47.4%). After partial lavage and administration, the rate of recovery was 76.3% within 2 weeks (29/38 ). Twenty-five children with recurrent or persistent wheezing, bronchofibroscopy showed obstruction of secretions caused by inflammation, 14 cases of stenosis, tracheobronchomalacia, 9 cases of stenosis and 2 cases of small foreign body. Satisfactory results were obtained after local lavage treatment effect. Of 29 chronic coughs, 4 were bronchial foreign bodies, 19 were chronic bronchitis, and the others were 6. 92 cases of children were treated with propofol painless anesthesia, oxygen saturation of 0.90 or more. Conclusion Pediatric painless fiberoptic bronchoscopy is very important for the diagnosis and treatment of atelectasis, recurrent or persistent wheezing, chronic cough and so on. It is of special value in the diagnosis of small bronchial foreign body. Propofol painless basic anesthesia under fiberoptic bronchoscopy, making the operation easier, reducing the risk and increase safety.