纤维支气管镜对小儿支原体肺炎的诊断价值分析

目的分析纤维支气管镜对小儿呼吸道疾病的诊断价值。方法选择我院2016年2月至2017年12月收治的96例支原体肺炎患儿作为研究对象,所有患儿均进行纤维支气管镜与支气管肺泡灌洗方式检查。分析比较两组方式对小儿支原体肺炎的诊断价值。结果纤维支气管镜对支原体肺炎诊断正确率为(94.79%),BALF对支原体肺炎诊断正确率为(78.12%),纤维支气管镜诊断正确率明显高于BALF,差异具有统计学意义(χ~2=11.388,P0.001)。结论纤维支气管镜可提高小儿支原体肺炎的诊断正确率,可在镜下直接观察患儿肺部相关情况,对疾病的诊断与治疗有着重要意义,具有较高的临床应用价值。     

经纤维支气管镜支气管肺泡灌洗对机械通气治疗溺水后呼吸衰竭的影响

目的观察经纤维支气管镜支气管肺泡灌洗对淹溺淡水污水后出现呼吸衰竭给予机械通气治疗的患者的疗效影响。方法35例淹溺污水后行机械通气治疗的患者,其中男性23例,女性12例;年龄18～67岁,平均年龄42.5岁。入院48 h内在机械通气状态下行经纤维支气管镜支气管肺泡灌洗治疗,比较入院时和入院48 h两组呼吸生理、呼吸力学及临床指标。结果抢救成功32例,死亡3例。与入院时相比,入院48 h氧合指数、呼吸频率、体温、吸气峰压等呼吸生理、呼吸力学及临床指标明显改善,比较上述两组指标,差异均有统计学意义(P<0.05),术中指脉氧监测无明显下降。结论经纤维支气管镜支气管肺泡灌洗在机械通气状态下治疗溺水所致呼吸衰竭的患者安全有效。     

13例肺泡蛋白沉积症出院病案分析与探讨

目的 提高医务人员对肺泡蛋白沉积症的认识，为临床提供资料、数据，充分发挥病案价值。方法 回顾性对我院呼吸疾病研究所2002-2005年出院的13例肺泡蛋白沉积症患者的病案资料进行归纳、总结、分析。结果 13例肺泡蛋白沉积症患者症状与体征缺乏特异性，临床确诊全部依赖胸腔镜或支气管纤维镜下肺活组织检查。结论 肺泡蛋白沉积症目前尚无彻底有效的药物治疗，支气管肺泡灌洗是迄今为止惟一被证明行之有效的治疗方法。     

有创机械通气的危重症患者支气管肺泡灌洗临床观察

目的观察经纤维支气管镜支气管肺泡灌洗和经吸痰管注水后吸出方式灌洗的临床效果。方法93例行机械通气的危重症患者,其中男性59例,女性34例,年龄18～92岁;随机分为两组。进行经纤维支气管镜支气管肺泡灌洗（A组）和经吸痰管注水后吸出方式灌洗（B组）。观察并比较两组对象灌洗前后的气道峰压（PIP）、内源性PEEP（PEEPi）、动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）及有创机械通气时间、重症监护病房（ICU）入住时间和病死率。结果两组的PIP和PEEPi较灌洗前均有明显下降;两组组间APIP、APEEPi比较,A组大于B组;两组的PaCO2较灌洗前有明显下降,两组的PaO2均较灌洗前有明显升高;A组分别在PaCO2降低和PaO2升高的程度上优于B组;A组有创机械通气时间和ICU入住时间均较B组明显缩短;以上比较差异均有统计学意义。但两组病死率差异无统计学意义。结论对有创机械通气的危重症患者进行经纤维支气管镜支气管肺泡灌洗或经吸痰管注水后吸出方式灌洗,均可以改善呼吸力学参数和血气参数。经纤维支气管镜支气管肺泡灌洗效果优于经吸痰管注水后吸出方式灌洗,值得广泛开展。     

早期纤支镜支气管肺泡灌洗术在肺不张幼龄儿童中的应用

目的:探讨早期纤支镜支气管肺泡灌洗术在肺不张幼龄儿童中的应用价值。方法:回顾性分析90例肺不张幼龄儿童患者临床资料,依照治疗方式,将行常规药物治疗患儿44例纳入A组,将在常规治疗基础上应用纤支镜支气管肺泡灌洗术患儿46例纳入B组,比较两组患儿临床疗效、血气分析指标、血液动力学水平及不良反应发生情况。结果:B组治疗有效率高于A组(91.30%vs 75.00%, P0.05);B组患儿治疗后动脉血氧分压、血氧饱和度水平高于A组,二氧化碳分压水平低于A组,差异均有统计学意义(P0.05);两组患儿治疗后血液动力学指标比较差异无统计学意义(P0.05);两组患儿不良反应发生率比较差异无统计学意义(P0.05)。结论:早期纤支镜支气管肺泡灌洗术可改善肺不张幼龄儿童血气指标,恢复患儿肺部张力,安全性较高。     

苏州医学院完成一项肺癌诊断研究

苏州医学院完成一项肺癌诊断研究据中华医学会信息，苏州医学院第一附属医院陶敏等为探讨支气管冲洗和肺泡灌洗液细胞ＤＮＡ含量分析对肺癌的诊断价值，用流式细胞仪对４３例肺癌和２５例肺良性病变患者的支气管冲洗和肺泡灌洗液细胞作了ＤＮＡ含量分析，与纤维支气管镜活...     

纤维支气管镜在小儿难治性肺炎中的应用分析

目的 探讨纤维支气管镜在小儿难治性肺炎中应用及临床效果.方法 选择2008年6月至2009年6月进修学习收集的经常规抗感染治疗2周后仍无效的小儿难治性肺炎50例(观察组),该组患儿均经纤维支气管镜检查后进行支气管肺泡灌洗.并将其与同期收治的30例不愿接受纤维支气管镜检查的难治性肺炎患儿(对照组)进行比较.结果 观察组经纤维支气管镜检查多数为支气管内膜炎,占86.0%(43/50).观察组显效47例,有效2例,总有效为98.0%(49/50)显著高于对照组73.3%(22/30),P<0.05.结论 纤维支气管镜有利于小儿难治性肺炎的诊断和治疗,值得临床推广.     

小儿肺不张的纤维支气管镜检查结果分析

目的 探讨小儿肺不张发生的原因。方法 对81例肺不张患儿行纤维支气管镜检查。经肉眼观察、支气管分泌物、肺泡灌洗液细胞学检查。结果 炎症：52例（包括2例痰栓），占64．2％，居首位；支气管异物24例，占296％。居第二位；支气管软化管口狭窄4例，占4.7％；来见明显异常1例，占1．3％。结论 在小儿引起肺不张的原因以炎症为主，异物次之。     

婴幼儿呼吸道发育畸形35例

目的探讨婴幼儿呼吸道发育畸形的临床特点和诊断方法。方法从2007年1月-2011年2月本院儿科在耳鼻喉科协助下采用pentaxFB-8V型或pentaxFB-15V型纤维支气管镜在静脉复合麻醉下对112例因反复咳嗽、气喘、反复肺炎。治疗效果差而住院的患儿行支气管镜检查。对呼吸道发育畸形的35例进行临床分析。结果呼吸道发育畸形患儿35例，占检查患儿总数的31．2％，以1岁内婴儿多见；临床表现为反复咳嗽、喘息，反复肺炎、哮喘。常规X线胸片、胸部CT，不能提供确诊依据，临床治疗效果差。发现呼吸道软化20例，呼吸道狭窄8例，气管性支气管3例，气管支气管开口异常2例，气管食管瘘1例，气管憩室1例。结论婴幼儿呼吸道发育畸形临床表现及影像学检查缺乏特异性，常易误诊，赖于纤维支气管镜检查确诊。     

纤维支气管镜下肺灌洗在严重肺部感染治疗中的临床意义

目的:评价纤维支气管镜(纤支镜)吸痰及支气管肺泡灌洗对严重肺部感染的治疗价值。方法:对26例重症肺部感染患者床边应用纤维支气管镜行吸痰和灌洗术,同时取痰培养根据药敏结果选择抗生素治疗。结果:痰培养26例,21例阳性,阳性率80.77%,无明显并发症发生。治疗2 w后,治愈13例,好转11例,有效率达84.62%。结论:对重症肺部感染患者尽早经纤支镜灌洗吸痰,明确病原菌及指导抗生素选用,提高治愈率,临床效果确切,安全性高,值得临床推广应用。     

不同时机支气管镜灌洗术治疗小儿腺病毒肺炎的临床研究

目的:探讨不同时机支气管镜灌洗术治疗小儿腺病毒肺炎的临床应用价值。方法:选取行支气管镜灌洗术的腺病毒肺炎小儿62例，依据灌洗术进行时机，将灌洗前病程<10 d的小儿设为早期组（n=31），将灌洗前病程≥10 d的小儿设为晚期组（n=31）。评估并比较两组治疗效果，灌洗后临床相关指标，灌洗前和灌洗48 h后血气指标［荧光素与蛋白质结合比率（F/P）、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、血氧饱和度（SpO2）］、体征指标［心率（HR）、呼吸频率（RR）、平均动脉压（MAP）］水平及感染学相关指标［C反应蛋白（CRP）、白细胞计数（WBC）］水平，记录两组并发症发生情况。结果:早期组与晚期组腺病毒肺炎小儿治疗总有效率分别96.77%和80.65%（P<0.05）；早期组灌洗后仍需机械通气小儿少于晚期组，且早期组热程、肺部啰音消失时间及住院时间均低于晚期组（P<0.05）；灌洗后早期组PaO2、F/P、SpO2高于晚期组，PaCO2低于晚期组（P<0.05）；两组灌洗前后体征指标比较均无统计学意义（P>0.05），灌洗后早期组CRP、WBC水平均低于晚期组（P<0.05）。结论:于灌洗前病程在10 d以内行支气管镜灌洗术可一定程度提高对小儿腺病毒肺炎的治疗效果。     

纤支镜吸痰＋支气管肺泡灌洗在机械通气患者治疗中的应用

目的：探讨纤维支气管镜（简称：纤支镜）吸痰＋支气管肺泡灌洗对机械通气患者的临床疗效。方法：回顾性分析接受机械通气治疗的34例呼吸衰竭患者的临床资料,均给予镇静镇痛、营养支持、抗感染等治疗;治疗组（n=17）行纤支镜吸痰＋支气管肺泡灌洗,对照组（n=17）行常规吸痰。比较两组治疗前后动脉血气分析、机械通气时问、肺部阴影消散时间、ICU住院时间、28d病死率等指标变化。结果：治疗前两组PaO2、PaCO2、SaO2、PaO2／FiO2相比较,差异均无统计学意义（P〉0．05）;治疗后,治疗组PaO2、SaO2、PaO：／FiO2升高和PaCO2下降与对照组比较,差异均有统计学意义（P〈0．05）;治疗组机械通气时间和肺部阴影消散时间短于对照组,差异有统计学意义（P〈0．05）,但ICU住院时间和28d病死率差异无统计学意义（P〉0．05）。结论：应用纤支镜吸痰＋支气管肺泡灌洗治疗机械通气患者,可以有效改善氧合和肺内通气,利于肺部炎症控制,但不改变病死率。     

Acute eosinophilic pneumonia as a reversible cause of noninfectious respiratory failure

Although chronic eosinophilic pneumonia is a well-known disorder, acute eosinophilic pneumonia has not been as well characterized. We describe the clinical features, results of bronchoalveolar lavage, and follow-up studies of four patients with acute eosinophilic pneumonia. The patients presented with an acute febrile illness, severe hypoxemia (partial pressure of arterial oxygen less than 60 mm Hg), diffuse pulmonary infiltrates, an increased number of eosinophils (mean +/- SEM, 42 +/- 4.8 percent) in bronchoalveolar-lavage fluid, and an absence of infection and previous atopic illness. The illness resolved rapidly after treatment with erythromycin and corticosteroids. The patients received doses of oral prednisone that were tapered over 10 days to 12 weeks, and none have relapsed since the steroids were discontinued. After a minimum follow-up period of five months, clinical evaluation, chest radiography, and pulmonary-function tests have shown no residual abnormalities attributable to the acute eosinophilic pneumonia. Follow-up bronchoalveolar lavage has demonstrated less than or equal to 1 percent eosinophils in all patients. We believe that we are describing an acute form of eosinophilic lung disease distinct from previously described syndromes. It can be diagnosed by bronchoalveolar lavage and seems to respond to treatment with corticosteroids.     

Impact of human metapneumovirus and human cytomegalovirus versus other respiratory viruses on the lower respiratory tract infections of lung transplant recipients

Viral respiratory tract infections in lung transplant recipients may be severe. During three consecutive winter-spring seasons, 49 symptomatic lung transplant recipients with suspected respiratory viral infection, and 26 asymptomatic patients were investigated for presence of respiratory viruses either in 56 nasopharyngeal aspirate or 72 bronchoalveolar lavage samples taken at different times after transplantation. On the whole, 1 asymptomatic (3.4%) and 28 symptomatic (57.1%) patients were positive for human metapneumovirus (hMPV, 4 patients), influenza virus A (3 patients), and B (2 patients), respiratory syncytial virus (2 patients), human coronavirus (2 patients), human parainfluenza virus (2 patients), rhinovirus (5 patients), while 4 patients were coinfected by 2 respiratory viruses, and 5 were infected sequentially by 2 or more respiratory viruses. In bronchoalveolar lavage samples, hMPV predominated by far over the other viruses, being responsible for 60% of positive specimens, whereas other viruses were present in nasopharyngeal aspirates at a comparable rate. RT-PCR (detecting 43 positive samples/128 examined) was largely superior to monoclonal antibodies (detecting 17 positive samples only). In addition, HCMV was detected in association with a respiratory virus in 4/18 HCMV-positive patients, and was found at a high concentration (>10(5) DNA copies/ml) in 3/16 (18.7%) patients with HCMV-positive bronchoalveolar lavage samples and pneumonia. Coinfections and sequential infections by HCMV and respiratory viruses were significantly more frequent in patients with acute rejection and steroid treatment. In conclusion: (i) about 50% of respiratory tract infections of lung transplant recipients were associated with one or more respiratory viruses; (ii) hMPV largely predominates in bronchoalveolar lavage of symptomatic lung transplant recipients, thus suggesting a causative role in lower respiratory tract infections; (iii) RT-PCR appears to be the method of choice for detection of respiratory viruses in lung transplant recipients, (iv) a high HCMV load in bronchoalveolar lavage is a risk factor for viral pneumonia, suggesting some measure of intervention for the control of viral infection.     

Two adult cases of influenza A/H1N1v virus pneumonia hospitalized in the Intensive Care Unit of the Reims University Medical Centre

During the 2009-2010 winter season, the new pandemic influenza A/H1N1 virus (S-OIV) was responsible for 1,334 hospitalized severe infection?cases including 312 (23.4%) deaths in metropolitan France. In the Champagne-Ardenne area (north eastern) this new epidemic strain was detected in the respiratory samples of 14?severe S-OIV infection cases resulting in 5?deaths. Here we report two of these 14?cases who were suffering from a bilateral pneumonia related to S-OIV infection and who were hospitalized in the Intensive Care Unit (ICU) of the Reims University Medical Centre during December 2009. These two patients were male with at least one known risk factor for severe S-OIV infection (chronic obstructive pulmonary disease (COPD) and morbid obesity, respectively); the COPD patient developed an acute respiratory distress syndrome. The etiological diagnosis of S-OIV infection was performed by use of a real time RT-PCR (rRT-PCR) assay allowing the detection of all the known human influenza A?viruses (rRT-PCR targeting the influenza gene M) and of the new influenza A/H1N1 pandemic strain. This rRT-PCR assay was positive in bronchoalveolar lavage samples taken from the two patients, whereas the nasal swab (using Virocult? collection system) appeared to be positive for only one of them. For both patients, a presumptive treatment combining oseltamivir and broad-spectrum antibiotics was started at the time of hospital admission, 24?hours at least before obtaining the results of the virological and bacteriological analyses. These two patients did not develop any secondary bacterial pneumonia and their clinical outcome was good after one and six weeks of hospitalization in ICU, respectively.     

Pneumocystis carinii Carriage in Immunocompetent Patients with Primary Pulmonary Disorders as Detected by Single or Nested PCR

Ninety-five bronchoalveolar lavage specimens from 63 immunocompetent adult patients with primary pulmonary disease were analyzed for Pneumocystis carinii colonization by primary and nested PCR. Twelve of 63 patients (19%) were PCR positive. None of them developed P. carinii pneumonia. These results suggest that P. carinii carriage may exist in immunocompetent patients with underlying pulmonary disease.     

Smoking-Induced Acute Eosinophilic Pneumonia in a 15-year-old Girl: A Case Report

Acute eosinophilic pneumonia is a very rare disease that is characterized by acute febrile respiratory failure, diffuse bilateral infiltrates on chest X-ray, and eosinophilia in bronchoalveolar lavage fluid in the absence of infection. We present the case of a 15-year-old girl diagnosed with smoking-induced acute eosinophilic pneumonia. A previously healthy young girl with a 1-day history of fever presented with cough, dyspnea, and diffuse bilateral infiltrates on chest X-ray. She had started smoking only 3 weeks before presentation. She was diagnosed by bronchoalveolar lavage fluid tests and lung biopsy and dramatically improved after steroid treatment. We emphasize that acute eosinophilic pneumonia must be considered when acute pneumonia does not respond to broad-spectrum antibiotics. Effective treatment and prompt institution of therapy can obviate unnecessary morbidity and mortality.     

Cryptogenic organizing pneumonia associated with invasive pulmonary aspergillosis: a case report and review of the literature

Background: Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with cryptogenic organizing pneumonia (COP) is scarce. Here, we report a case where COP was a presenting feature in a patient with diagnosed IPA, and review additional 58 COP patients reported in the literature from 1988 through 2013. Case outline: The study was reviewed and approved by the Institutional Ethics Committee of Shanghai Tenth People’s Hospital of Tongji University and was conducted in compliance with the Helsinki Declaration. Written informed consent was obtained from patient. A 56-year-old man presenting with productive cough for several weeks and unremitting high fever for a week was hospitalized with an initial clinical diagnosis of pneumonia, for which antibiotics were prescribed but did not work. Seeing that the condition progressed both clinically and radiographically, bronchoscopy, bronchoalveolar lavage and lung biopsy were performed, and the diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-existence was made. Initially, the patient responded to steroid pulse therapy and voriconazole treatment, and his condition was partially improved. However, the patient’s condition deteriorated progressively 5 months after the disease onset and the patient died during the third admission due to respiratory failure and the adverse reactions of coriaceous hormone therapy. Conclusion: The diagnosis of cryptogenic organizing pneumonia (COP) and invasive pulmonary aspergillosis (IPA) co-occurrence depends on clinical, radiological and histological presentations. Similarities with other disease processes could lead to a delayed diagnosis or misdiagnosis. The present case suggests that clinicians should be alert to this disease in their clinical practices.     

Clinical features of patients with acute respiratory illness and rhinovirus in their bronchoalveolar lavages.

BACKGROUND: Several reports in selected populations suggest that human rhinovirus (HRV) may be responsible for lower respiratory tract infections or pneumonia. We describe clinical features of all patients with rhinovirus cultured from their bronchoalveolar lavage (BAL) during a 10-yr period in a tertiary care center. METHODS: Results for viral culture of all lower respiratory specimens performed during a 10-year period at the University of Virginia Health Sciences Center were reviewed. A case was defined as any patient with a positive culture for HRV in a BAL specimen. A comprehensive review of the patients' medical records was performed. In one case, in situ hybridization (ISH) was performed in order to identify whether rhinoviral RNA was present in bronchial biopsy specimens. RESULTS: During the 10-year study period viruses were identified in 431 lower respiratory tract specimens, and were most frequently cytomegalovirus or herpes simplex virus. Twenty patients (ages, 2.5-86 year) had a bronchoalveolar specimen culture positive for HRV. All had an abnormal chest radiograph, 60% were admitted to the intensive care unit, and 25% expired during their hospitalization. In 18 patients (90%) various severe underlying conditions were identified including solid organ transplants in seven, malignancies in four and AIDS in two. An immunosuppressive disease or condition requiring immunosuppressive therapy was present in all cases. In addition to HRV, one or more potential pathogens were identified in respiratory specimens from 14 patients (70%). Histopathological abnormalities, ranging from fibropurulent debris in alveoli to diffuse alveolar damage, were present in 6 of 13 bronchial biopsies. In two cases without any other significant pathogens than HRV, acute inflammations with fibropurulent debris in alveoli were observed. One lung transplant patient showed intermittent recovery of HRV in her respiratory specimens during a 15-week time period, but ISH did not show HRV RNA in bronchial epithelial cells. CONCLUSION: Our observations suggest that HRV recovery from BALs or lower respiratory tract samples in highly immunocompromised patients is associated with severe lower respiratory tract illness. Whether HRV directly causes viral pneumonia or predispose to pulmonary injury and/or superinfection remains uncertain.