Rock M J
Department of Pediatrics, University of Tennessee--Memphis.
Pediatrics. 1995 Mar;95(3):373-7.
To assess the diagnostic utility of bronchoalveolar lavage (BAL) in a heterogeneous group of immunocompetent children with unexplained infiltrates on chest radiograph.
This was a retrospective case series.
The setting was a tertiary care referral center in an urban children's hospital.
Twenty-five consecutive children, median age 4 years 6 months, had flexible bronchoscopy with BAL. Preprocedure diagnoses were right middle-lobe syndrome (3 patients), granulomatous lung disease (3 patients), adult respiratory distress syndrome (3 patients), and persistent infiltrate on chest x-ray (16 patients). The majority of patients were receiving parenteral antibiotics before bronchoscopy. BAL fluid was sent for bacterial, viral, fungal, and, if indicated, mycobacterial cultures.
Twenty-seven procedures were performed in 25 patients. A specific diagnosis was made in eight (30%) of the procedures. Four patients had viral infections, two had fungal infections, one had a bacterial infection, and one had a mixed fungal and bacterial infection.
Submitting BAL fluid for bacterial, viral, and fungal culture can be helpful in diagnosing infection in immunocompetent children. Empiric antibiotic therapy remains the standard treatment for pneumonia in children. Bronchoalveolar lavage may yield a diagnosis in patients unresponsive to empiric antibiotics. Careful selection of patients, a bronchoscopist skilled in the procedure, and the risk/benefit ratio all must be considered.
评估支气管肺泡灌洗（BAL）对一组胸部X线片有无法解释的浸润影的免疫功能正常儿童的诊断效用。
这是一项回顾性病例系列研究。
研究背景为一家城市儿童医院的三级医疗转诊中心。
连续25名儿童接受了BAL的可弯曲支气管镜检查，中位年龄为4岁6个月。术前诊断为右中叶综合征（3例）、肉芽肿性肺病（3例）、成人呼吸窘迫综合征（3例）以及胸部X线片持续存在浸润影（16例）。大多数患者在支气管镜检查前接受了胃肠外抗生素治疗。BAL液被送去进行细菌、病毒、真菌培养，如有指征则进行分枝杆菌培养。
25例患者共进行了27次操作。其中8次（30%）操作做出了明确诊断。4例患者为病毒感染，2例为真菌感染，1例为细菌感染，1例为真菌和细菌混合感染。
送检BAL液进行细菌、病毒和真菌培养有助于诊断免疫功能正常儿童的感染。经验性抗生素治疗仍然是儿童肺炎的标准治疗方法。支气管肺泡灌洗可能会对经验性抗生素治疗无反应的患者做出诊断。必须综合考虑患者的精心选择、熟练掌握该操作的支气管镜医师以及风险/效益比。
