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[可弯曲支气管镜在儿童感染相关性肺不张治疗中的作用]

[Role of flexible bronchoscopy in the treatment of infection-associated atelectasis in children].

作者信息

Liang Yu, Liu Xi-cheng, Jiang Qin-bo

机构信息

Center For Bronchoscopy, Beijing Children's Hospital Affiliated to Capital University of Medical Sciences, Beijing 100054, China.

出版信息

Zhonghua Er Ke Za Zhi. 2003 Sep;41(9):649-51.

Abstract

OBJECTIVE

Infection-associated atelectasis is rather common during childhood and the effects of drug therapy are often unsatisfactory. The present study aimed to evaluate the effectiveness of flexible bronchoscopy in the treatment of infection-associated atelectasis in children.

METHODS

One hundred and twenty-five patients (68 male and 57 female; age ranged from 10 d to 14 years and their courses of disease were from 3 d to 2.5 years) with infection-associated atelectasis confirmed by chest X-ray or CT were enrolled in the study. The following conditions were excluded by bronchoscopy: airway foreign body, airway anomalies, tumor, tuberculosis. The patients were divided into two groups: flexible bronchoscopy group and medication group. In the flexible bronchoscopy group, 65 patients were treated mainly with flexible bronchoscopy whereas in medication 60 group patients only received medication. Chest X-ray or CT was regularly reviewed for every patient, meanwhile the effect of flexible bronchoscopy at different courses of disease was observed.

RESULTS

Flexible bronchoscopy group and medication group had no significant differences in age, sex and course of disease (P > 0.05). In flexible bronchoscopy group 39 patients were cured, 20 were improved and 6 cases had no change; in medication group 17 patients were cured, 25 were improved and 18 had no change. The two groups had significant differences (P < 0.01); in bronchoscopy group there were significant differences among patients with the courses of disease less than 3 months, 3 to 6 months and more than 6 months.

CONCLUSIONS

The authors concluded that flexible bronchoscopy was an effective method for treatment of infection-associated atelectasis. Flexible bronchoscopy can reach pathological part and clear pus and granulation. It can remove obstruction and relieve symptoms. When course of disease was short, bronchoscopic therapy was advantageous to recovery of atelectasis. Bronchial washing may overcome the shortcomings of bronchoalveolar lavage, therefore the former seemed to be more suitable for treatment of infection-associated atelectasis.

摘要

目的

感染相关性肺不张在儿童时期较为常见,药物治疗效果往往不尽人意。本研究旨在评估纤维支气管镜在治疗儿童感染相关性肺不张中的有效性。

方法

纳入125例经胸部X线或CT确诊为感染相关性肺不张的患者(男68例,女57例;年龄10天至14岁,病程3天至2.5年)。通过支气管镜检查排除以下情况:气道异物、气道畸形、肿瘤、结核。将患者分为两组:纤维支气管镜组和药物治疗组。纤维支气管镜组65例患者主要接受纤维支气管镜治疗,而药物治疗组60例患者仅接受药物治疗。定期对每位患者进行胸部X线或CT复查,同时观察纤维支气管镜在不同病程中的治疗效果。

结果

纤维支气管镜组和药物治疗组在年龄、性别和病程方面无显著差异(P>0.05)。纤维支气管镜组39例治愈,20例好转,6例无变化;药物治疗组17例治愈,25例好转,18例无变化。两组差异有统计学意义(P<0.01);纤维支气管镜组病程小于3个月、3至6个月和大于6个月的患者之间差异有统计学意义。

结论

作者得出结论,纤维支气管镜是治疗感染相关性肺不张的有效方法。纤维支气管镜可到达病变部位,清除脓液和肉芽组织。它可以解除梗阻,缓解症状。病程较短时,支气管镜治疗有利于肺不张的恢复。支气管冲洗可能克服支气管肺泡灌洗的缺点,因此前者似乎更适合治疗感染相关性肺不张。

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