儿童气道异物的诊断治疗

Diagnosis and Treatment of Airway Foreign Bodies in Children

目的探讨儿童气道异物的诊断、治疗及并发症发生的原因,以减少误诊及降低并发症的发生率。方法回顾分析2009年1月-2010年8月经病史、症状、体征及辅助检查(胸部X线检查或CT扫描)初诊为气道异物的317例患儿的临床资料。所有患儿均行支气管镜检查,明确有异物者行异物取出术,对术中、术后并发症的原因和处理方法进行总结。结果本组患者中有105例(33.1%)患儿曾被误诊为支气管肺炎或其他呼吸系统疾病,经支气管镜检及异物取出术后,出现并发症者共35例,包括:喉痉挛8例(22.8%),支气管痉挛6例(17.1%),支气管黏膜出血12例(34.3%),皮下气肿8例(22.8%),死亡1例(2.8%)。结论儿童气道异物一经确诊或高度怀疑,应尽快行支气管镜检查,以保持呼吸道通畅。手术操作应轻柔准确,并注意观察患儿全身状况,是减少并发症的关键。

Objective To explore the diagnosis, treatment and complication causes of airway foreign bodies in children in order to reduce complication and misdiagnosis rate. Methods Between January 2009 and August 2010, retrospective study was carried out on 317 patients with trachea foreign bodies in order to summarize complication causes and treatment methods. Results The number of the male patients was more than the females （2.1 ： 1）, and patients from rural areas were more than those from the urban （3.4 ： 1）; it is common in children under the age of 3 （83.5%）. Peri-operative and post-operative complications included： laryngospasmin 8 （22.8%）, bronchospasm in 6 （17.1%）, bronchial mucosal bleeding in 12 （34.3%）, subcutaneous emphysema in 8 （22.8%）, and death in 1 （2.8%）. Conclusions Once the diagnosis of airway foreign body confirmed or highly is suspected, the surgery ofbronchoscopy examination should be make as soon as possible. Keeping under observation and accurate operation are important to reduce complications.