婴幼儿支气管异物的临床特征、肺部影像学及支气管镜下特点分析

Clinical feature,lung imaging and bronchoscope characteristics analysis of infant bronchial foreign body

目的通过对30例婴幼儿支气管异物的临床特点、肺部影像学特点和异物的镜下位置、异物种类、异物对气道的刺激后黏膜的变化进行系统分析，探讨支气管异物患儿临床特征、肺部影像学、支气管镜下特点及局部麻醉下应用小儿电子纤维支气管镜（fiber bronchoscope，FBO）技术在婴幼儿支气管异物确诊和取出中优势。方法对2014年9～12月在盛京医院小儿支气管镜室应用F-t10证实并取出异物的30例患儿，年龄0—3岁，对其临床特点、肺部影像学特征以及支气管镜下特点以及取出方式进行系统性分析。结果在30例患儿中，无呛咳病史6例（20．0％），其中无咳喘症状3例（10．0％），出现咳喘症状的3例（10．O％），有明确异物呛咳史的患儿24例（80．0％），其中无咳喘症状的7例（23．3％），出现咳喘症状的17例（56．7％）。在体征方面：无呛咳病史的患儿中呼吸音正常2例（6．7％），出现喘鸣音3例（10．0％），患侧呼吸音减弱的1例（3．3％）；有呛咳病史的患儿中呼吸音正常的6例（20．0％），出现喘鸣音的12例（加．0％），患侧呼吸音减弱的6例（20．0％）；肺部影像学特点缺乏特异性表现：本组30例仅有1例显示异物，其他29例均无特异性表现，肺叶气肿13例（43．3％），是主要的影像学特点，影像学表现正常2例（6．7％）；镜下发现异物在左肺19例（63．4％），异物周围肉芽形成21例（70．0％），阻塞远端气道内黏膜坏死痰栓形成5例（16．7％）；异物吸人中位数时间4．5d[2．8，12．5]，异物吸人的时间同肉芽增生有显著相关性（R=0．688，P=0．000）。术中出现的主要不良反应：低氧6例（16．7％），一过性发热12例（40．0％），持续性发热1例（3．3％）。结论经FBO局部麻醉下对儿童异物的诊断较其他方法准确率高，并且经FBO局部麻醉下进行支气管异物取出术是一种安伞、有效的方法．

Objective To investigate the advantages of pediatric electronic fiber bronchoscope （FBO） in the infant bronchial foreign body, discuss the clinical features of infant bronchial foreign body, lung imaging characteristics and the kinds of microscopically position, the change of airway mucosa after stimulation by for- eign body under local anesthesia in 30 cases of infant bronchial foreign body. Methods Thirty cases, aged 0 to 3 years,were collected from September to December,2014. All of them were with foreign bodies examined by FBO in pediatric bronchoscopy room in Shengjing Hospital of China Medical University. Results In all infants, 6 cases （20. 0% ） without history of inhaled foreign bodies and 24 cases （ 80. 0% ） with a record history of in- haled. In the aspects of signs： normal breath sounds with a history of no choking cough in children were 2 cases （6. 7% ） ,wheezing sounds were 3 patients （ 10. 0% ） and weakened side breath sound was 1 case （3.3%） ;with a history of choking cough in children,6 cases（20. 0% ） with normal breath sounds,12 cases（40. 0% ） with wheez- ing,6 cases（20. 0% ） with lateral breath sounds less. Lung imaging characteristics was lack of specific perform- ance：only a case of all（n =30） show foreign body directly. Otherwise,other 29 cases had no specificity. Lung em- physema in 13 cases （43.3%） is the main characteristic,while normal imaging findings in 2 cases （6. 7% ）. For- eign Ixxties in 19 cases were in the left lung （63.4%） and 21 cases（70. 0% ） of foreign body stimulated granula- tion inside airway,necrosis sputum bolt in distal obstruction of airway occured in 5 cases （ 16. 7% ）. Inhalled time of foreign body in airway was 4. 5 [2.8,12.5] day and inhalled time of foreign body in airway correlation coefficient with granulation hyperplasia（r =0. 688,P =0. 000） ,there was a significant correlation. Main adverse reaction was low oxygen in 6 cases （ 16. 7% ）. Conclusion The diagnostic accuracy of FBO under local anesthesia on children is high- er than other methods,and the FBO bronchial foreign bodies under local anesthesia is a safe and effective method.