目的 探讨纤维支气管镜(纤支镜)在婴幼儿肺不张诊断和治疗中的应用价值及其安全性.方法经X线胸片或CT证实为肺不张的86例住院婴儿,分为纤支镜组(59例)及对照组(27例).对纤支镜组的临床资料进行分析,并与对照组进行比较.结果纤支镜组患儿共进行74例次纤支镜术,纤支镜下发现支气管黏膜炎性改变56例,其中黏液性痰栓31例,伴气管软化11例,支气管狭窄5例,外源性异物5例.16例患儿支气管肺泡灌洗液(BALF)细菌培养阳性,涂片发现结核杆菌1例,白色念珠菌1例;2例检出肺含铁血黄素细胞.出院时,纤支镜组患儿完全复张48例(81.36%),平均住院天数(12.52±0.23)d;对照组完全复张13例(48.15%),平均住院天数(17.30±0.31)d;差异均有统计学意义(P均<0.05).在纤支镜操作过程中17例次(22.97%)出现一过性氧饱和度降低,22例次(29.73%)出现一过性心率加快,未出现感染、心跳骤停或其他严重并发症.结论纤支镜术有利于明确婴幼儿肺不张的病因,促进肺不张恢复,缩短平均住筏天数,安全性较好.%Objective To explore the role and safety of fiberoptic bronchoscopy in the diagnosis and treatment of atelectasis in infants. Methods A total of 86 hospitalized infants with atelectasis confirmed by chest X-ray or CT were enrolled in this study and divided, into two groups, flexible bronchoscopy group (n=59~) and control group (n—27). 'The clinical data were analyzed and. compared, between two groups. Results Totally 74 flexible fiberoptic bronchoscopies were performed, in 59 infants of bronchoscopy group. The bronchial inflammatory changes were observed in 56 infants, among whom, 31 infants had mucinous sputum, 11 infants had bronchomalacia, 5 infants had bronchial marrow and 5 infants had exogenous foreign bodies. The bacterial culture of bronchoalveolar lavage fluid (BALF) was positive in 16 infants. One infant had M. tuberculosis and one infant had Candida albicans by smear inspection. The pulmonary hemosiderin cells were observed in 2 infants. At discharge, in bronchoscopy group, 48 infants (81.36%) had their lungs fully reexpanded and the average length of hospital siay was (12.52 I 0.23) d; in control group, 3 3 infants (48. 15%) had their lungs fully reexpanded and the average length of hospital stay was (17.30 + 0.3 3) d. There were significantly differences between two groups (P<0.05). Among 74 flexible fiberoptic bronchoscopies, transient oxygen saturation reduction was occurred in 17 cases (22.97%) and transient heart rate increase was occurred in 22 cases (29.73%). There were no serious adverse events, such as infection, cardiac arrest or other serious concurrent complications. Conclusions Flexible bronchoscopy is effective in confirming the etiology of atelectasis and promoting lite reexpansion of lung. Its use is safe in infants
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