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目的 探讨电子支气管镜检查在先天性心脏病(CHD)术后脱机困难患儿中的应用价值.方法 收集广东省妇幼保健院2012年12月-2016年12月期间因CHD行手术治疗后脱机困难患儿(年龄2月～8岁)共68例临床资料进行回顾性分析,其中行电子支气管镜检查30例(干预组),未行支气管镜检查共38例(对照组),统计引起患儿脱机困难的病因比例,对比两组患儿有创机械通气时间,下调呼吸机吸入氧浓度(FiO2)、呼吸颈率(RR)、吸气峰压(PIP)、呼气末正压(PEEP)等数据的时间,同时对比两组患儿氧分压 (PaO2)上升及二氧化分压(PaCO2)下降情况.结果 干预组患儿的病因诊断为呼吸道大量痰栓形成(90.0％),气道狭窄或软化(73.3％),喉部水肿(26.7％),喉软骨软化(16.7％),气道渗血(6.7％)、气管食管瘘(3.3％)和支气管异物(3.3％);干预组患儿有创机械通气时间、下调FiO2时间、下调PIP时间均较对照组患儿明显缩短,差异有统计学意义(t=178.3、66.3、49.6,均P＜0.05),但下调RR时间与下调PEEP时间较对照组间差异无统计学意义(t=52.8、89.2,均P＞0.05);干预组患儿血气改善情况明显快于对照组患儿,差异有统计学意义(t=41.9、70.2,均P＜0.05).结论 电子支气管镜检查有助于尽早明确CHD患儿术后脱机困难病因;电子支气管镜肺泡灌洗术可明显加快降低CHD脱机困难患儿呼吸机参数,改善患儿血气分析情况,缩短呼吸机使用时间.“,”Objective To explore the application value of electronic by bronchosscopy in childreu with machine disconnection-related difficulty after congenital heart disease (CHD) surgery.Methods Sixty-eight children aged two months to 8 years with machine disconnectionrelated difficulty after CHD surgery were selected,then the clinical data was analyzed retrospectively.All the children were divided into intervention group (30 children undergoing eleetronic bronchoscory) and control group (38 children not undergoing electronic bronchoscopy).The causes of machine disconnection-related difficulty were analyzed.The time of invasive mechanical ventilation,the down-regulation fime of inhaled oxygen conceutration (FiO2),respiratory rate (RR),peak inspiratory pressure (PIP),positive end-expiratory pressure (PEEP)of ventilator,increase amplitudes of partial pressure of oxygen (PaO2) and decrease amplitudes of partial pressure of carbon dioxide (PaCO2) in the two groups were compared.Results The causes of machine disconnection-related difficulty in intervention group were respiratory tract sputum bolt obstruction (90.0％),airway stenosis or malacia (73.3％),laryngeal stenosis (26.7％),laryngomalacia (16.7％),airway errhysis (6.7％),tracheoesophageal fistula (3.3％),and foreign body in bronchus (3.3％).The time of invasive mechanical ventilation,the down-regulation time of FiO2 and PIP in intervention group were statistically significantly shorter than those in control group (t=178.3,66.3,49.6,all P＜0.05).There was no statistically significant difference in the down-regulation time of RR and PEEP between the two groups (t =52.8,89.2,P＞0.05).The improvements of blood gas in intervention group were statistically significantly faster than those in control group (t =41.9,70.2,P＜0.05).Conclusion Electronic bronchoscopy is conducive to early diagnosis of machine disconnection-related difficulty after CHD surgery in children.Bronchoalveolar lavage under electronic bronchoscopy can significantly quicken the decrease of respiratory ventilation parameters,improve the indexes of blood gas analysis,and shorten the application time of ventilator in children with machine disconnection-related difficulty after CHD surgery.