Glória C, Freitas M G
Unidade de Pneumologia, Hospital de Santa Marta, Lisboa.
Acta Med Port. 1995 Sep;8(9):493-6.
Fiber-optic bronchoscopy is commonly performed in patients with non resolving pneumonia to exclude endobronchial neoplastic tumours. Radiographic resolution of community-acquired pneumonia is variable, depending on several factors, as the causative agent or host dependent factors. Therefore, the decision to perform a bronchoscopy is sometimes empirical. To describe our experience in this subject we reviewed the clinical registrations and the bronchoscopy protocols of 123 consecutive patients with community-acquired pneumonia that did not show significant radiographic resolution after at least ten days of antibiotic therapy. A histological diagnosis of malignant neoplasia was obtained in 5.6% of the cases. All patients were males, more than 55 years old and heavy smokers (more than 40 pack/year). The comparison between this risk group and the other patients showed statistically significant differences in age and tobacco consumption. Symptom duration, haemoglobin, leukocytes, sedimentation rate, renal or hepatic tests were not significantly different in both groups. We recommend that fiber-optic bronchoscopy must be performed early in heavy smokers, patients over 55 years of age with slow or non resolving pneumonia. In non-smokers or younger patients, it should only be performed after 4 to 8 weeks, unless clinical symptoms justify an earlier observation.
对于非消散性肺炎患者，通常会进行纤维支气管镜检查以排除支气管内肿瘤。社区获得性肺炎的影像学消散情况各不相同，取决于多种因素，如病原体或宿主相关因素。因此，进行支气管镜检查的决定有时是经验性的。为了描述我们在这个问题上的经验，我们回顾了123例连续的社区获得性肺炎患者的临床记录和支气管镜检查方案，这些患者在接受至少十天的抗生素治疗后，影像学上没有明显的消散。5.6%的病例获得了恶性肿瘤的组织学诊断。所有患者均为男性，年龄超过55岁且为重度吸烟者（每年超过40包）。该风险组与其他患者之间在年龄和烟草消费量方面存在统计学上的显著差异。两组在症状持续时间、血红蛋白、白细胞、血沉率、肾脏或肝脏检查方面没有显著差异。我们建议，对于重度吸烟者、55岁以上且肺炎进展缓慢或未消散的患者，应尽早进行纤维支气管镜检查。对于非吸烟者或年轻患者，除非临床症状需要更早检查，否则应在4至8周后进行。
