【摘要】 目的　评价小儿支气管肺泡灌洗术 (BAL)对胸片浸润灶伴肺不张和 /或肺气肿患儿的诊断与治疗作用。方法　172例胸片显示持续浸润灶伴肺不张和 /或肺气肿 ,患儿经抗生素治疗而疗效不显著者 ,均作 BAL,支气管肺泡灌洗液(BAL F)进行免疫球蛋白、炎症介质检测、细胞分类、细菌培养。结果　镜检发现支气管异物 80例 ;支气管内生性脓栓 87例 ;支气管内膜结核 2例 ;支气管腺瘤 1例 ;支气管畸形 2例。172例 BAL F中 5例真菌培养阳性 ,17例细菌培养阳性 ;炎性介质相对增高。BAL 后期用抗生素和激素行灌洗治疗 ,术后针对病因选用敏感抗生素治疗。其症状消失、胸片恢复正常时间 1～ 7天。结论　对于胸片有浸润灶伴肺不张和 /或肺气肿的患儿 ,病程长于一般肺炎者 ,无论有无异物呛咳史通过作支气管镜检 ,通过BAL F,分析炎性介质 ,以利于明确感染性质。提高治愈率。更多还原

【Abstract】 Objective To evaluate the diagnosis and treatment of children with unexplained infiltrates on chest radiograph by bronchoscopy and bronchoalveolar lavage (BAL).Methods 172 patients with chest X ray films showing unexplained infiltrates were inefficacy by treatment of antibiotics and subjected to the bronchoscopy and BAL.BAL fluid underwent the determination of immunoglobulin and inflammatory mediator,and cell classification and bacteria culture.Results Patients were identified as follows:bronchial foreign body in 80 cases,endogenous pus in 87 cases,bronchial intima tubercle in 2 cases,bronchial adenoma in 1 case and bronchial deformity in 2 cases.Five cases out of 172 cases were positive for fungus,17 for bacteria in BALF,and the inflammatory mediators were also incerased relatively.In the post period of BAL antibiotics and hcrmone were used for lavage,which had been leading in antibiotics treatment.After bronchoscopy and lavage treatment,the symptoms of patients had been disappeared in post operation period.Chest radiograph was normal.The course of disease was shortened in 1 to 7 days.Conclusion Bronchoscopy and examination was necessary for children with persistent infiltrates on chest radiograph and pulmonary emphysema or atelectasis,especially,for those with the course of disease longer than that of the common.Whether the patients had a history of foreign body inhaling or not,BALF analysis would be helpful for obtaining a correct diagnosis and improving curative rate.更多还原