本文選題：氣管支氣管軟化　切入點：支氣管鏡　出處：《吉林大學》2014年碩士論文

【摘要】：目的： 探討小兒氣管支氣管軟化癥（TBM）的發(fā)病情況、支氣管鏡下病變特征、臨床特點、并分析支氣管鏡術在其診治中的價值，為TBM的臨床診斷和治療提供依據(jù)。 方法： 選取2009年1月至2013年10月，吉林大學第一醫(yī)院小兒呼吸科年齡＜5歲、常規(guī)診治無明顯好轉(zhuǎn)的反復或持續(xù)性喘息、反復肺炎、慢性咳嗽等患兒共201例，所有患兒均符合支氣管鏡檢查適應癥，對其行支氣管鏡檢查，確診TBM69例。對69例TBM患兒臨床資料進行回顧性分析，包括一般情況、鏡下病變特征、臨床癥狀、體征、輔助檢查、治療、轉(zhuǎn)歸。 結(jié)果： 1.性別構成：男52例，女17例，男女比例約為3:1；男孩TBM檢出率高于女孩，性別差異有統(tǒng)計學意義（P＜0.05）。 2.年齡構成：年齡最小為6天，最大4歲；＜1歲40例，1~3歲27例，＞3歲2例；＜1歲TBM檢出率明顯高于其它年齡組，差異有統(tǒng)計學意義(P＜0.01）。 3.軟化部位：氣管軟化12例，氣管-支氣管軟化17例，支氣管軟化40例；右肺支氣管軟化多于左肺。軟化程度以輕中度軟化為主(90%)。 4.33例合并其它氣道發(fā)育異常,4例合并先天性心臟病,2例合并食管閉鎖。 5.69例TBM患兒中，反復或持續(xù)性喘息32例，慢性咳嗽18例，反復肺炎6例，肺不張8例，呼吸困難2例，長期痰鳴2例，呼吸機輔助通氣撤機困難1例。 6.69例TBM全部由支氣管鏡明確診斷，胸部X線平片及胸部CT平掃、氣道三維重建均未提示TBM。 7.鏡檢術中，根據(jù)鏡下炎癥情況對局部病變進行灌洗。經(jīng)治療66例癥狀明顯緩解出院，1例氣管切開帶管出院，2例死亡。 結(jié)論： 1.本組資料顯示TBM多見于男孩及小于1歲患兒。 2. TBM臨床表現(xiàn)多樣，多為反復或持續(xù)性喘息、咳嗽，，容易誤診、漏診。 3.支氣管鏡對小兒TBM診斷有確診價值。
[Abstract]:Objective:. To investigate the incidence of tracheobronchomalacia in children, the pathological features and clinical features under bronchoscopy, and to analyze the value of bronchoscopy in the diagnosis and treatment of TBM, and to provide the basis for the clinical diagnosis and treatment of TBM. Methods:. From January 2009 to October 2013, 201 children with recurrent or persistent wheezing, recurrent pneumonia, chronic cough, and so on, were selected from the Department of Pediatric ventilation in the first Hospital of Jilin University, whose age was less than 5 years old. All the children were in accordance with the indications of bronchoscopy. The clinical data of 69 patients with TBM were analyzed retrospectively, including general condition, pathological features, clinical symptoms, signs and auxiliary examinations. Treatment, return. Results:. 1. Sex composition: 52 males and 17 females, the ratio of male to female was about 3: 1.The detection rate of TBM in boys was higher than that in girls (P < 0.05). 2. Age composition: the minimum age was 6 days, the maximum was 4 years old, the age < 1 year old was 40 cases, the age was 3 years old in 27 cases, > 3 years old in 2 cases, the detection rate of < 1 year old TBM was significantly higher than that of other age groups, the difference was statistically significant (P < 0.01). 3. There were 12 cases of tracheomalacia, 17 cases of tracheobronchomalacia, 40 cases of bronchiomalacia, and 40 cases of bronchomalacia in right lung. 4.33 cases with other airway dysplasia 4 cases with congenital heart disease 2 cases with esophageal atresia. There were 32 cases of recurrent or persistent wheezing, 18 cases of chronic cough, 6 cases of recurrent pneumonia, 8 cases of atelectasis, 2 cases of dyspnea, 2 cases of chronic phlegm and 1 case of ventilator assisted ventilation. 6. 69 cases of TBM were clearly diagnosed by bronchoscopy, chest X-ray plain film and chest CT plain scan, three dimensional reconstruction of the airway did not reveal TBM. 7.Intraoperative lavage of local lesions was carried out according to the inflammatory conditions under microscope. One case with tracheotomy and tube discharged from hospital died after 66 cases of symptoms were obviously relieved and discharged from hospital. Conclusion:. 1. The data showed that TBM was more common in boys and children under 1 years old. 2. The clinical manifestations of TBM were varied, including recurrent or persistent wheezing, cough, misdiagnosis and missed diagnosis. 3. Bronchoscopy is valuable for the diagnosis of TBM in children.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R725.6

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