经支气管镜肺活检在现代儿科介入呼吸病学的应用

经支气管镜肺活检(transbronchial lung biopsy,TBLB)技术在成人呼吸科的应用较为广泛,已成功用于诊断一些肺部疾病。目前,TBLB在儿童肺部疾病中应用较少。该文对TBLB术及其在儿科介入呼吸病学中的应用进行介绍,让更多儿科同道对该技术有更多认识。     

虚拟支气管镜导航系统引导支气管镜儿童肺外周病变活检1例

患儿男, 10岁, 以"确诊横纹肌肉瘤5年余, 咳嗽13 d"于2021年7月入北京儿童医院呼吸二科, 既往规律放疗、化疗。门诊查胸部CT发现左下肺野内团状高密度影, 为明确诊断于虚拟支气管镜导航系统引导下, 经支气管镜行肺外周病变活检术留取样本, 病理诊断横纹肌肉瘤(左下)肺转移, 术中术后无并发症发生, 确诊后转儿童肿瘤内科调整化疗方案继续治疗。     

呼吸系统疾病

001856纤维支气管镜在儿科呼吸系统疾病诊治中的应用及分析/刘玺诚…//中国实用儿科杂志一1999,14(9)一548一550 400例中进行纤支镜术614例次,支气管肺泡灌洗(BAL)540例次,BAL液病原学培养371例次,气管粘膜、肺活检101例次,取气管异物67例次。成功地解决了儿童特别是新生儿、婴     

经支气管镜介入治疗在气道发育异常中的应用

支气管镜是诊治儿童呼吸系统疾病不可缺少的方法之一,是儿童肺介入治疗技术不断发展的基础。随着临床经验的不断积累及支气管镜在儿科的广泛应用,其价值得到了一致肯定。该文将对经支气管镜介入治疗在气道发育异常中的应用概况作一综述。     

电磁导航技术在现代儿科介入呼吸病学的应用

电磁导航支气管镜技术凭借其具有实时导航、精准定位的优势在外周病变的活检、纵隔和肺门淋巴结病变的活检及需要肺部、气道、纵隔精确定位的呼吸介入术中具有很高的临床应用价值,经过十多年的临床实践,认为该技术具有安全、可靠、微创、高效等优点,更重要的是适合儿童使用。该技术在儿科呼吸领域的引入和推广,将推动儿科呼吸介入诊疗的进一步发展。     

正确应用新技术 提高儿童呼吸系统疾病的诊治水平

小儿呼吸系统疾病的发病率和死亡率均居儿科疾病的首位。提高小儿呼吸道疾病的诊治水平，是呼吸专业儿科医生的艰巨任务和奋斗目标。沿用至今的一些有创伤和无创伤技术，如胸部Ｘ线诊断术、超声波检查术、肺功能试验、血液气体分析、同位素肺闪烁扫描，气管、支气管镜、胸腔镜检查和肺活检等一直是被应用和倡导应用的诊治手段。近十几年特别是进入９０年代以来随着全球和全国科学技术的全方位发展，新医疗仪器和新技术不断涌现。多学一点知识，更新诊治观念，正确掌握和应用新技术，为呼吸道疾病患儿消除痛苦，是新世纪儿科呼吸学家将面临的…     

伴有气道病变的儿童先天畸形支气管镜下相关表现(上)

2009年,中华医学会儿科学分会呼吸学组儿科支气管镜协作组,根据我国儿童特点制定了<儿科支气管镜术指南(2009年版)>[1]用以规范和指导我国儿童支气管镜术的开展.支气管镜是诊断儿童气道病变的重要手段.现就伴有气道病变的小儿先天畸形的支气管镜下表现做一介绍.     

经支气管冷冻肺活检在儿童弥漫性实质性肺病诊断中的应用

病理诊断对弥漫性实质性肺病的诊治具有极为重要的指导意义,获取理想肺组织是病理诊断的基础。目前获得肺组织的方法有外科肺活检、经支气管肺活检和经支气管冷冻肺活检。鉴于外科肺活检术后严重并发症风险高、经支气管肺活检获得肺组织标本小且结构不完整,在临床实践中经支气管冷冻肺活检可作为成人弥漫性实质性肺病获取病理的一线微创手段。全球范围内儿童经支气管冷冻肺活检的报道较少,该文针对这一技术在儿童病例中的应用进行了阐述。     

可弯曲支气管镜术在儿科的应用指征

可弯曲支气管镜术已成为儿童呼吸系统疾病诊断和治疗不可缺少的重要手段之一,综合欧洲、澳大利亚和2009年我国制定的相关指南或建议,可弯曲支气管镜术在儿科临床应用的指征为(1)呼吸道阻塞的诊断和评估:吸气性喘鸣或呼吸异常声音,治疗反应不佳的持续或反复呼气性喘息;(2)胸部放射学异常:持续存在或复发性肺不张、肺炎、肺侵润影或肺部团块病变;(3)不明原因的慢性咳嗽和咯血;(4)ICU和新生儿患者的诊治.借助可弯曲支气管镜,可以实施清除呼吸道黏液栓、恢复呼吸道通畅,支气管肺泡灌洗,病灶刷检和活检,局部给药等治疗和操作.     

现代儿科呼吸介入技术在肺不张中的应用进展

肺不张是儿童呼吸系统常见疾病，其病因复杂多样，治疗方式也多种多样。随着儿科支气管镜介入技术的发展，近年来其在儿童肺不张的治疗中发挥了越来越重要的作用。文章旨在简要阐述儿科支气管镜介入技术如支气管肺泡灌洗术、局部注药给药术、毛刷刷取术、球囊扩张术、消融术、支架置入术及异物钳取术等在儿童肺不张诊治中的进展。     

现代儿科呼吸介入技术在肺不张中的应用进展

肺不张是儿童呼吸系统常见疾病，其病因复杂多样，治疗方式也多种多样。随着儿科支气管镜介入技术的发展，近年来其在儿童肺不张的治疗中发挥了越来越重要的作用。文章旨在简要阐述儿科支气管镜介入技术如支气管肺泡灌洗术、局部注药给药术、毛刷刷取术、球囊扩张术、消融术、支架置入术及异物钳取术等在儿童肺不张诊治中的进展。     

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??Respiratory tract infection is one of the most common diseases in pediatric patients with various clinical presentation and severity ranges from mild upper respiratory tract illnesses to serious or fatal lower respiratory tract disease. Virus is one of the most common respiratory pathogens??especially in infants and young children. Rapidly establishing the viral etiology of a respiratory illness with high sensitivity and specificity is of important. In recent years??more and more new techniques and methods for viral etiological diagnosis have been developed. Advantages and short comes for various diagnostic techniques and methods in clinical practice are compared and discussed here for reference.     

Pediatric cardiac intensive care: current state of the art and beyond the millennium

Pediatric cardiac intensive care has emerged as a distinct clinical entity to meet the unique needs of pediatric patients with congenital and acquired heart disease. This new subspecialty demands expertise and experience in the pediatric subspecialties of cardiology, intensive care, cardiac surgery, cardiac anesthesia, neonatology, and others. Ten recent developments will have an impact on pediatric cardiac intensive care for the coming decades: 1) emergence of new patient populations; 2) new clinical methodologies in the treatment of pulmonary hypertension; 3) innovations in techniques of respiratory support; 4) expanding research of single ventricle physiology; 5) advances in the treatment of heart failure; 6) improved noninvasive imaging; 7) new directions in interventional cardiac catheterization; 8) new techniques in pediatric cardiac surgery; 9) use of computer technology and intensive care monitoring; and 10) appreciation for global economics of intensive care. Finally, a multidisciplinary approach with a team esprit de corps remains vital to a successful pediatric cardiac intensive care program.     

现代儿科呼吸介入技术在肺部感染性疾病病原学检测方法中的应用进展

肺部感染是5岁以下儿童死亡的主要病因， 肺部感染特别是重症肺部感染 ，诊断和治疗成功的关键是找到病原进行针对性抗微生物治疗。现代儿科呼吸介入技术不仅能获得支气管肺部病灶的液体性标本； 也能获得气管腔内组织标本和肺组织标本， 同时联合导航技术又让这些镜下呼吸介入技术采样更加精准、 安全。加上病原微生物学检测技术的进步， 使得儿科肺部感染病原微生物得到明确诊断率大大提高。因此， 现代儿科介入肺科医生要熟悉和掌握这些儿科呼吸介入技术及其在儿科肺部感染病原学检测的优缺点， 在临床抉择过程中才能做出正确选择。     

The role of rigid and flexible bronchoscopy in children

Bronchoscopy for paediatric respiratory disease is a routine procedure in paediatric pulmonology. Rigid bronchoscopy is now much less commonly used than flexible bronchoscopy. Technological advances have brought better picture quality and easier storage of video documentation. Indications with clear clinical benefit are congenital or acquired unexplained airway obstruction. In pulmonary infections or infiltrates in immunodeficient or immunosuppressed children not responding to empirical treatment a pathogen may be identified by bronchoscopy and bronchoalveolar lavage (BAL). Bronchoscopy and BAL can be indicated in children with unusual presentations of chronic cough or wheeze, and cystic fibrosis. The use of transbronchial biopsies (TBB) is established in paediatric lung transplantation. New applications and techniques are being developed, such as endobronchial ultrasound and transbronchial needle biopsy of lymph nodes and the role of airway stent placement have become better understood.     

Noninvasive respiratory support

Noninvasive ventilation (NIV) refers to the delivery of ventilatory support using techniques that do not require an endotracheal airway. Noninvasive ventilation is being used with increased frequency in a variety of clinical situations in the emergency department, intensive care unit, and prehospital environment. This article reviews the history of NIV, the rationale for its use, and the evidence of efficacy in both the adult and pediatric literature. This article also describes equipment and techniques currently available for administration of NIV as well as new trends in noninvasive respiratory support.     

Oral and nasal enteral tube placement errors and complications in a pediatric intensive care unit.

OBJECTIVE: To report five cases of errors in the placement of oral/nasal enteral tubes in a pediatric intensive care unit, and to review literature on placement techniques and complication rates. DESIGN: Case series and review of the literature. SETTING: A 19-bed pediatric intensive care unit in a tertiary care pediatric hospital. PATIENTS: A 14-yr-old male with respiratory distress following a near drowning, a 10-yr-old male with recurrent acute lymphocytic leukemia and Pneumocystis carinii pneumonia, a 16-yr-old female with complex congenital heart disease and respiratory failure, a 16-yr-old male with status asthmaticus, and a 2-yr-old male with congenital heart disease. INTERVENTIONS: None. MAIN RESULTS: Five cases of enteral tube placement errors occurred in our combined medical-surgical pediatric critical care unit within the past year. All five resulted in placement of the feeding tube in the respiratory tract, four occurred despite the presence of cuffed endotracheal tubes. Three of the five patients had subsequent worsening of their respiratory status. One developed a pneumothorax, one developed pulmonary hemorrhage, and one developed an increased oxygen requirement. CONCLUSIONS: Patients in the pediatric intensive care unit may have characteristics that place them at an increased risk for misplacement of oral or nasal enteral tubes into the respiratory tract. Placement of enteral tubes into the respiratory tract may cause serious morbidity and possibly mortality. Checking the placement of enteral tubes with traditional methods does not prevent misplacement in the respiratory tree, and new techniques should be considered.     

Support of respiratory failure in the pediatric surgical patient

Severe respiratory failure in newborn and pediatric patients is associated with significant morbidity and mortality. Basic science laboratory investigation has led to advances in the understanding of ventilator-induced lung injury and in optimizing the supportive use of conventional ventilation strategies. Over the past few years, progress has been made in alternative therapies for supporting children and adults with severe respiratory failure. This review will focus on recent laboratory and clinical data regarding the techniques of lung protective ventilator strategies, inhaled nitric oxide, liquid ventilation, and extracorporeal life support (ECLS, ECMO). Some of these modalities are commonplace, while others may have much to offer the pediatric clinician if their benefit is clearly demonstrated in future clinical trials.     

Pediatric aerosol therapy guidelines. Indications, techniques, and dosages

Delivery of medication in aerosol form to the pediatric population is an important therapeutic module. Aerosol therapy allows rapid medication effects, reduces systemic side effects, and provides uniform results in comparable clinical presentations if preparation techniques and dosages are appropriate. The effectiveness of aerosol therapy is dependent upon several key factors, and techniques developed to emphasize these factors will maximize aerosol delivery into the tracheobronchial tree. Indications for medical aerosol therapy are specific for children, and individualized treatment can be structured for a wide variety of pulmonary disorders. Proper and successful administration of aerosol therapy to the infant or child requires a comprehensive amount of skill and knowledge on the part of the respiratory therapy practitioner. Guidelines discussed in this paper will assist the respiratory care practitioner in achieving optimal results in treating airway disease in the pediatric patient.