O'Sullivan Brian P, Finger Lenna, Zwerdling Robert G
Department of Pediatrics, University of Massachusetts Medical School, UMass Memorial Health Care, Worcester, MA 01655, USA.
Chest. 2004 Apr;125(4):1265-9. doi: 10.1378/chest.125.4.1265.
To evaluate the practice of using nasopharyngoscopy without routine fiberoptic bronchoscopy for children presenting to a pediatric pulmonary practice with nonspecific noisy breathing.
Retrospective chart review. Records of patients who underwent nasopharyngoscopy between January 1, 1990, and December 31, 1999, were reviewed. Follow-up was obtained by office records and direct contact with the patient's family and/or primary care physician.
Academic, tertiary care facility.
Eighty-one children who underwent upper airway endoscopy to evaluate noisy breathing consistent with extrathoracic lesions were identified. One child had two evaluations separated by years for differing complaints, making a total of 82 procedures. Stridor was the chief complaint in three fourths of the children. Half of the children with stridor were found to have laryngomalacia. Long-term follow-up was available for 75 of 81 children, with median follow-up of 6 years (range, 1 to 13 years). No medical problems related to missed airway lesions developed in any infants initially evaluated using nasopharyngoscopy.
Nasopharyngoscopy without lower airway endoscopy can be used safely for the initial evaluation of noisy breathing in infants and children provided excellent follow-up is available.
评估在儿科肺部门诊就诊的有非特异性呼吸杂音的儿童中，不进行常规纤维支气管镜检查而仅使用鼻咽镜检查的做法。
回顾性病历审查。对1990年1月1日至1999年12月31日期间接受鼻咽镜检查的患者记录进行审查。通过门诊记录以及与患者家属和/或初级保健医生直接联系获取随访信息。
学术性三级医疗设施。
确定了81名接受上呼吸道内镜检查以评估与胸外病变相符的呼吸杂音的儿童。一名儿童因不同主诉在数年中接受了两次评估，共计82次检查。四分之三的儿童主要症状为喘鸣。一半有喘鸣的儿童被发现患有喉软化症。81名儿童中有75名获得了长期随访，中位随访时间为6年（范围1至13年）。最初使用鼻咽镜检查进行评估的任何婴儿均未出现与漏诊气道病变相关的医疗问题。
如果有良好的随访，不进行下呼吸道内镜检查而仅使用鼻咽镜检查可安全地用于婴儿和儿童呼吸杂音的初始评估。
