儿童支气管异物的临床特征分析

The clinical characteristics of bronchial foreign body in children

目的通过对182例经纤维支气管镜检出的支气管异物进行回顾性分析,掌握儿童支气管异物的发病特点。方法选择2012年1月至2016年12月经纤维支气管镜证实存在的支气管异物患儿182例,根据有无呛咳史,分为有呛咳史组122例和无呛咳史组60例。比较2组的病程、胸部影像学差异性,分析异物吸入的种类、位置以及细菌检出率等。结果182例中行胸部透视(胸透)检查67例,总阳性率为44.8%;所有患儿行胸部高分辨CT(HRCT)检查,总阳性率为96.7%。支气管异物的位置、左肺78例,右肺99例,双侧1例,气管4例。182例中行肺泡灌洗液细菌培养检查127例,细菌培养阳性率为21.3%。术中及术后并发症:3例(1.6%)低氧血症,给予及时再次操作成功取出,出现术后一过性发热16例(8.8%),支气管异物一次未取尽12例(6.6%),均在第2次气管镜时取出,无死亡病例。结论支气管异物好发年龄在19个月龄幼儿,有呛咳史者不能因呼吸音对称而放弃进一步检查,对于呛咳史不明的慢性咳嗽即使呼吸音对称只要病程超过15 d均应警惕支气管异物的可能;胸部HRCT对于诊断支气管异物有较高的敏感性,纤维支气管镜对于气管分叉以下的坚果类异物取出具有独特优势且安全,便于在儿科广泛开展。

Objective To retrospectively analyze the clinical data about 182 children with bronchial foreign body,and to investigate the clinical characteristics of bronchial foreign body in children.Methods A total of 182 children patients with bronchial foreign bodies that were confirmed by fiber bronchoscope from January 2012 to December 2016 were enrolled in the study,who were divided into bucking group and non-bucking group according to the bucking history,and the course of disease,pulmonary respiratory sounds and the chest imaging,the types and location of the foreign bodies as well as bacteria detection rate were observed and compared between the two groups.Results Among the 182 patients,67 patients were examined by chest fluoroscopy(chest X-ray),and the total positive rate was 44.8%.All patients underwent chest high resolution CT(HRCT)examination,with a total positive rate being 96.7%.In the aspects of locations of the bronchial foreign bodies,78 cases on the left lung,99 cases on the right lung,1 case on the both sides of the bronchial,4 cases on the trachea,of whom,bacterial culture of alveolar lavage fluid was examined in 127 patients,and bacterial culture positive rate was 21.3%.In the aspects of intraoperative and postoperative complications,transient hypoxemia occurred in 3 patients(1.6%),postoperative transient fever occurred in 16 patients(8.8%),moreover,the bronchial foreign bodies were not removed completely in the first time in 12 patients(6.6%),which were removed completely at the second time,no death cases were found.Conclusion The research results show that bronchial foreign body is more common in infants with 19 months of age.Chest HRCT is highly sensitive in diagnosis of bronchial foreign body.Streptococcus pneumoniae,enterobacter cloacae and haemophilus influenzae are the most common bacteria in bronchoforeign body alveolar lavage fluid.Moreover fiberoptic bronchoscopy has unique advantages for removal of nut foreign bodies below the bifurcation of the trachea,which is convenient to be widely carried out in department of pediatrics.