摘要
目的探讨肺脏超声监测下用纤维支气管镜(纤支镜)进行支气管肺泡灌洗( bronchoal-veolar lavage,BAL)治疗新生儿肺不张的疗效及安全性.方法 2018年6月至2018年12月29例患儿经肺脏超声确诊为肺不张,经常规机械振动排痰无效后,纤支镜下行BAL治疗.术前所有患儿均在超声监测下找出肺不张所在的肺段,经纤支镜注入0. 9%NaCl溶液(1~2 ml/kg),然后抽吸,保证灌洗液回收率>50%,每次灌洗后立即用超声监测患儿肺不张恢复程度决定是否继续灌洗,1个疗程可连续进行BAL 1~3次,每日1个疗程,最多灌洗3个疗程.分析超声监测下纤支镜进行BAL治疗新生儿肺不张的疗效、不良反应及并发症.结果 29例患儿经纤支镜进行BAL治疗后,治愈25例(86. 2%),有效3例(10. 3%),无效1例(3. 4%).所有患儿在治疗过程中生命体征均稳定,其中11例(37. 9%)出现一过性低氧血症,3例(10. 3%)出现气管黏膜损伤,哭声嘶哑2例(6. 9%).未出现肺出血、气胸、心搏骤停等危重并发症.结论肺脏超声监测下纤支镜进行BAL治疗肺不张效果明显、操作简便、无辐射、无明显不良反应和并发症,值得在临床推广应用.
Objective To evaluate the efficacy and safety of bronchoalveolar lavage(BAL) in the treatment of neonatal atelectasis with fiberoptic bronchoscopy under ultrasound monitoring. Methods From June 2018 to December 2018, 29 children were diagnosed as atelectasis by lung ultrasound.After conventional mechanical vibration and sputum ineffective, BAL was treated with fiberoptic bronchoscopy.All patients before operation were monitored by ultrasound to find the lung segment where the atelectasis was located.0.9% NaCl solution was injected by fibrobronchoscope(1~2 ml/kg), and then sucked to ensure the recovery rate of the lavage fluid was more than 50%.After each lavage, ultrasound was immediately used to monitor the recovery of atelectasis to determine whether or not to continue the lavage.One course of treatment could be continuously performed BAL 1 to 3 times a day, 1 course per day, and up to 3 courses of lavage.We analyzed the efficacy, adverse reactions and complications of BAL in the treatment of neonatal atelectasis under ultrasound monitoring. Results Twenty-nine patients underwent BAL treatment with fiberoptic bronchoscopy, 25 cases (86.2%) were cured, 3 cases (10.3%) were effective, and 1 case (3.4%) was ineffective.All children had stable vital signs during treatment.Among them, 11 cases (37.9%) had transient hypoxemia, 3 cases (10.3%) had tracheal mucosal injury, and 2 cases (6.9%) had hoarseness.There were no serious complications such as pulmonary hemorrhage, pneumothorax, and cardiac arrest. Conclusion BAL treatment of atelectasis under lung ultrasound monitoring has obvious effect, easy to operate, no radiation, no obvious adverse reactions and complications, which is worthy of clinical application.
作者
王英俊
刘璐
董玉斌
栾永刚
曹亚芹
黄娜娜
Wang Yingjun;Liu Lu;Dong Yubin;Luan Yonggang;Cao Yaqin;Huang Nana(Department of NICU, Zhoukou Central Hospital of Henan Province, Zhoukou 466000, China;Department of Ultrasound, Zhoukou Central Hospital of Henan Province, Zhoukou 466000, China)
出处
《中国小儿急救医学》
CAS
2019年第8期596-599,共4页
Chinese Pediatric Emergency Medicine
