纤维支气管镜术在儿童肺炎支原体肺炎诊治中的应用

摘要

Objective To investigate the application of flexible bronchoscopy to diagnosis and treatment of children with Mycoplasma pneumoniae pneumonia ( MPP).Methods Clinical data of 204 MPP patients who had flexible bronchoscopy examination were retrospectively analyzed.Results The main clinical manifestations were fever ( 74.5％ ), frequent cough ( 47.5％ ), wheezing ( 15.7％ ), pleural effusion ( 29.9％ ) and chest pain ( 12.7％ ), shortness of breath ( 11.3％ ), atelectasis ( 53.4％ ), pleural patients also showed postive MP-DNA in bronchoalveolar lavage fluid ( BALF ).BALF bacterial culture of 25 cases ( 12.3％ ) were positive.Under flexible bronchoscope, all patients showed obviously bronchial mucosa congestive edema.The incidence of bronchial phlegm blocking was 26.5％, The incidence of sputum bolt formation was 14.2％, The incidence of inflammatory stricture was 10.3％, The incidence of nodule-like protuberances was 6.4％.Different degrees of ciliated columnar epithelial damage were showed in 20 cases by bronchial biopsy electron microscopy.After alveolar wash and administration of medicines, 97.2％ of the atelectasis cases were cured.Conclusions Flexible bronchoscopy and bronchoalveolar lavage should be applied as soon as possible in refractory MPP and atelectasis cases to promote lung recruitment and improve the outcome.%目的 探讨纤维支气管镜术(纤支镜)在儿童肺炎支原体肺炎(MPP)中的应用价值.方法 回顾性分析204例行纤支镜术的MPP患儿的临床资料.结果 204例患儿中共进行了286例次纤支镜术.血清MP-IgM抗体阳性患儿121例(59.3%)支气管肺泡灌洗液(BALF)中FQ-MP-DNA阳性,BALF细菌培养阳性菌株25株(12.3%).纤支镜镜下所见病变部位黏膜充血水肿,支气管开口痰堵54例(26.5%),形成痰栓29例(14.2%),炎性狭窄21例(10.3%),小结节样突起13例(6.4%);20例支气管黏膜组织电镜检查纤毛超微结构均有不同程度的纤毛柱状上皮损害.全部病例均进行肺泡灌洗治疗,合并肺不张的109例患儿经1～4次灌洗治疗,1个月后复查106例(97.2%)完全或部分复张.结论 对于难治性MPP、合并肺不张者,早期应用纤支镜进行支气管肺泡灌洗治疗,能促进肺复张,改善预后,减少后遗症的发生.