摘要
目的评价纤维支气管镜和支气管肺泡灌洗术在小儿难治性肺炎诊治中的作用。方法对常规抗感染治疗超过2周仍无效的54例难治性肺炎患儿进行纤维支气管镜检查,对其中41例进行支气管肺泡灌洗,灌洗液作细胞学检查和细菌定量培养。结果镜检结果示单纯炎症病变27例(50%),异物吸入12例(22%),支气管肺发育异常5例(9%),肺部出血性疾病4例(7%),气管支气管软化3例(6%),支气管内膜结核2例(4%),Kartagener综合征1例(2%)。难治性肺炎患儿中3岁以内婴幼儿多见,为38例(70%)。41例行支气管肺泡灌洗者的灌洗液细胞数中位数515×109/L[(55～3900)×109/L];中性粒细胞比例中位数63%(0～98%),其中27例(66%)>25%。27例单纯炎症与14例伴其他病变(异物、支气管肺发育异常和出血性病变)患儿灌洗液的细胞数和中性粒细胞比例差异无统计学意义。灌洗液致病菌培养阳性者中性粒细胞比例高于寄生菌阳性者(P<0.05)。细菌培养阳性15例(37%),定量培养菌落≥104cfu/ml9株(≥105cfu/ml仅1株)。吞噬细菌中性粒细胞阳性2例。3例经纤支镜行支气管黏膜活检,其中支气管内膜结核2例,Kartagener综合征1例。结论纤支镜检查和支气管肺泡灌洗术是小儿难治性呼吸系统疾病诊断的一种非常有效的措施。镜检、灌洗液细胞学检查、细菌定量培养以及活检病理检查相结合可提高诊断的正确性。在小儿难治性肺炎中,灌洗液培养以细菌生长≥104cfu/ml为界,作为致病菌,而呼吸机相关肺炎(VAP)时,≥103cfu/ml也应考虑为致病菌。
Objectives To evaluate the value of fiberoptic bronchoscopy as well as bronchoalveolar lavage（BAL） in diagnosis and treatment of refractory pneumonia in children. Methods Total 54 patients who failed to respond to a two weeks,routine antibiotic therapy were diagnosed as having refractory pneumonia. They were examined with fiberoptic bronchoscopy. BAL,cytology and quantitative culture of BAL fluid were performed in 41 of them. Results Morphology study showed that there were 27 patients（50%）with simple inflammation,12（22%）with foreign body aspiration,4 （7%）with pulmonary hemorrhagic disease,5（9%）with bronchopulmonary dysplasia,2（4%）with endobronchial tuberculosis,and 1（2%）with Kartagener syndrome. Thirty-eight of the 41 patients（70%）were younger than 3 year of age. The results of cytology of bronchoalveolar lavage fluid（BALF）showed that median number of cells was 515 × 10^9/L（55 ～ 3 900 × 10^9/L）,and median percentage of neutrophils was 63%（0 ～ 98%）. The median percentage of neutrophils was 〉 25% in 27 of the 41 patients（66%）. The differences in the number of cells and the percentage of neutrophils between patients with simple inflammation and those with other pathology were not statistically significant. The neutrophil percentage of BALF was higher in the patients with positive pathogen culture than those with positive parasitic bacteria. Among 15 patients（37%）with positive bacteriology culture,9 showed strains ≥ 10^4 cfu/ml in quantitative culture（only 1 with strain ≥10^5 cfu/ml）. Cells containing intracellular organisms were seen in 2 patients. Three biopsy samples obtained through fiberoptic bronchoscope showed that two patients with endobronchial tuberculosis,and 1 with Kartagener syndrome. Conclusions Fiberoptic bronchoscopy and bronchoalveolar lavage are very effective methods in diagnosis of refractory respiratory diseases in children. Combination of morphology of endobronchial,cytology and quantitative culture of BALF,and pathologic diagnosis of biopsy can greatly increase the accuracy of diagnosis. Bacterial growth ≥10^4 cfu/ml BALF in children with refractory pneumonia or ≥ 10^3 cfu/ml in ventilator-associated pneumonia could be considered as a cut-off in diagnosing bacterial infection.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2008年第9期811-815,共5页
Journal of Clinical Pediatrics
关键词
纤维支气管镜
支气管肺泡灌洗
难治性肺炎
儿童
fiberoptic bronchoscope
bronchoalveolar lavage
refractory pneumonia
children
