降低小儿气管支气管异物并发症及病死率的诊断和治疗方案分析

How to reduce the incidence of complication and mortality in pediatric tracheobronchial foreign body patients

目的 总结一套诊断和治疗方案 ,进一步降低小儿气管支气管异物的并发症率及病死率。方法 分析北京儿童医院 1987年 1月～ 2 0 0 3年 8月 72 6 0例小儿气管支气管异物患儿疗效 ,总结采用快速诊断方案 ,应用术前评估体系 ,建立围手术期治疗方案的效果。结果 应用快速诊断方案共实施气管镜检查术 76 18例 ,其中术后证实为气管异物的有 72 6 0例 ,诊断符合率达 95 3%。 72 6 0例小儿气管支气管异物病例中 ,2 4h内做出诊断并实施气管镜检的为 70 0 7例 ,占 96 4 %。无麻醉或表面麻醉 6 933例 ,全身麻醉及表面麻醉复合 32 7例 ,病史超过 1个月或为特殊类型的气管异物采用全身麻醉及表面分段麻醉相复合的麻醉方法 ,无麻醉并发症出现。 716 5例一次手术成功 ,占总手术98 7% ,95例实施二次或二次以上手术 ,16例转为纤维支气管镜取异物 ,12例由气管镜手术转至胸科开胸取出异物 ,其余 6 7例于二次气管镜手术时顺利取出异物。术后出现并发症 7例 ,占 0 1% ,其中 1996年以前 6例 ,1996年后对所有病例进行术前评估后再处理 ,手术并发症仅 1例。无死亡病例。结论 快速诊断 ,术前评估 ,实施适时有效的手术和围手术期治疗 ,可以有效降低小儿气管支气管异物的并发症率 ,降低死亡率。

Objective To analyze the experience for the diagnosis and treatment of pediatric tracheobr onchial foreign body cases, so to the incidence of complications and mortality. Methods 7260 tracheobronchial foreign body cases, from 1987 through 2003, were enrolled in this study. Early diagnosis, preoperative evaluation and perioperative treat ment were strongly emphasized in this group of patients. Results 7618 patients received rigid bronchoscopy and 7260 cases were confirmed with tr acheobronchial foreign bodies. The confirmed diagnosis rate is 95.3%. Among t he 7260 cases, 7007(96.4%) patients were diagnosed and received bronchoscopic f oreign body removal within 24 hours. Different food is the most common foreign body aspirated in infants and toddlers(under 4 year old), whereas older child ren are more likely to aspirate other foreign bodies. Peanuts and sunflower see d (6862) were noted as the most common ones. Pen caps (398) are much less. All patients were evaluated before surgery after 1996. Complications occurred in 7 patients(0.1%). The mortality rate is zero. 7165 cases′ foreign body were s uccessfully removed the first time of brochoscopy. 95 patients received more th an one times bronchoscopy. 67 cases′ foreign bodies were smoothly removed with second bronchoscopy. 16 cases received flexible bronchoscopic foreign body rem oval when rigid bronchoscopic procedure failed. 12 cases received chest surgery for foreign body removal. 6933 cases received bronchoscopy with surface anesth esia or without anesthesia, while 327 patients with general anesthesia combined local surface anesthesia. Conclusions Rapid diagnosis and treatment can reduce the complication and mortality rate. So that early diagnosis, preoperative evaluati on and perioperative treatment should be strongly emphasized.