小儿呼吸道异物1276例临床分析

Clinical analysis of tracheobronchial foreign bodies in children in 1276 cases

目的:探讨呼吸道异物的有效治疗方案,以降低其并发症和死亡率。方法:分析1276例小儿呼吸道异物患者的麻醉、手术方法及治疗效果。全身麻醉下行支气管镜异物摘取术1275例,单纯喉气管插管未手术1例,并分析3例死亡原因。结果:静脉复合麻醉下支气管镜异物摘取术1197例,1次手术成功取出异物1196例;吸入性乙醚麻醉下支气管镜异物摘取术78例,1次手术成功取出异物65例,2次手术成功取出异物12例。气管切开3例。术后并发喉水肿12例,其中乙醚麻醉者11例,静脉复合麻醉者1例。静脉复合麻醉者最长手术时间达45min,进镜5次,未发生喉水肿;吸入性乙醚麻醉者允许手术时间5～10min,进镜次数最多3次,否则喉水肿严重。窒息死亡3例,死亡率为0.24%。结论:静脉复合麻醉配合咽喉气管黏膜表面麻醉是支气管镜异物摘取术理想的麻醉方法,豆类异物或伴肺不张者危险大,年龄越小危险越大,应高度重视,对有些病例气管切开仍是必要的治疗手段。

Objective：To investigate the effective therapy methods of foreign bodies in respiratory tract to lower it＇s complications and the mortality rate. Method：Review the anesthesia methods, operation methods and therapeutic efficacy of 1 276 cases of foreign body in respiratory tract and report three cases of death. Result： Under total intravenous anesthesia we took out foreign bodies by bronchoscope in 1 197 cases and did that successfully for the first time in 1 196 cases. Under aspiration anesthesia by ether we took out foreign bodies by bronchoscope in 78 cases and did that successfully for the first time in 65 cases, we took foreign bodies for the second time in 12 cases. We carried out tracheotomy in three cases. Edema of larynx was found in 12 cases among which 11 cases were under aspiration anesthesia by ether and one case was under total intravenous anesthesia. Under total intravenous anesthesia, the longest time of operation was 45 minutes, we could carry out the examination by bronchoscope for five times and no edema of larynx was found in all cases. Under aspiration anesthesia by ether, the longest time of operation was limited to 5-10 minutes, we could carry out the examination by bronchoscope for three times at most; otherwise, edema of larynx was very severe. Three cases died over apnea. Mortality rate is about 0.24%. Conclusion：Total intravenous anesthesia combined with surface anesthesia of respiratory tract-mucosa is the ideal anesthesia method for taking out foreign bodies in respiratory tract by bronchoscope. It is more dangerous in cases that the foreign bodies are bean or that atelectasis is found. We should notice that the less the patients are, the more dangerous the operation is. In some cases tracheotomy is needed.