床旁纤维支气管镜检查在重症免疫抑制相关性肺病中的应用

目的探讨纤维支气管镜检查在重症免疫抑制相关性肺病中的应用价值。方法80例免疫抑制相关性肺病患者中有25例(31·2%)重症患者进行了经纤维支气管镜支气管肺灌洗,对其中10例(40%)进行透壁肺活检。分别对肺灌洗液和肺组织进行病原学和病理学检查。结果25例重症免疫抑制相关性肺病中,18例(72%)培养出病原微生物,7例(28%)培养阴性。其中细菌12例(66·7%),真菌6例(33·3%),细菌与真菌混合感染者3例。10例肺活检患者中有5例患者得到明确的病理诊断,5例为非特异性病理学改变。检查过程中25例患者中有6例(14%)血氧饱和度显著下降,4例(16%)术后少量咯血,2例(8%)在随后机械通气过程中发生气胸。结论对重症免疫抑制相关性肺病患者早期进行气管镜检查能提高病原微生物的检出率,及时指导调整治疗方案,进行针对性治疗。恰当的运用经气管镜肺活检,能进一步明确肺部并发症的性质,提高诊断正确率。对重症免疫抑制相关性肺病患者进行纤维支气管镜检查是安全可行的。

Etiologic and pathologic studies by fibrobronchoscopy in patients with severe immunocompromised lung diseases

Objective To investigate the clinical significance of etiologic and pathologic study by fibrobronchoscopy(FB)examination in severe immunocompromised lung diseases.Methods FB examination and bronchoalveolar lavage (BAL) was performed in twenty-five patients with immunocompromised lung diseases meamwhile transbronchial lung biopsy (TBLB) was conducted in ten patients.BAL fluid (BALF) and biopsy specimen were sampled for pathogenic and pathological study.Results Among twenty-five patients,eighteen (72%) had a positive pathogenic yield in which twelve (66.7%) were confirmed as bacteria infection and six (33.3%) were confirmed as fungal infection.Pathological study established definite diagnosis in five patients and revealed non-specific findings in other five patients.Complications of FB examination included serious hypoxemia in six patients (14%),haemoptysis in four patients (16%),and pneumonthorax following the subsequent mechanical ventilationin in two patients (8%).Conclusions Early etiologic and pathologic studies by FB examination have high diagnostic sensitivity and specificity for patients with severe immunocompromised lung diseases and are valuable to guide therapeutical regimen.