特殊类型的小儿气管支气管异物的处理

Management of irregular shaped airway foreign body in children

目的 探讨小儿气管、支气管特殊类型异物的有效处理方法。方法 回顾 1998年 1月～ 2 0 0 0年 11月北京儿童医院治疗的 48例气管、支气管特殊异物 (塑料笔帽、玩具、哨、大头针、图钉、乳牙、笔头、钢珠、杏核、鸡骨头、螺丝钉 )的处理过程。患儿年龄最小 9个月 ,最大 14岁 ,平均 8.3岁。男∶女为 2 .4∶1。结果 46 / 48例特殊异物经气管镜取出 ,其中 3例异物经过声门处被刮脱 ,出现呼吸窘迫 ,再由对侧支气管取出。 1例图钉异物从气管切开口处取出 ,1例杏核异物开胸取出。结论小儿气管、支气管特殊异物术中采用全身麻醉 ,保留自主呼吸 ,取异物时需做好应变的准备。应正确判断和处理并发症 ,对从声门取出确有困难的异物可从气管切开口处取出。

Objective To explore proper operative methods for removal of irregular shaped foreign bodies in children. Methods Forty eight emergency cases of irregular shaped airway foreign bodies (plastic ball pen cap, mini toys, whistle, pin, thumbtack, milk tooth, pen, steel ball, stone of apricot, chicken bone and screw nail) from Jan. 1998 to Nov. 2000 have been reviewed, especially the operative procedure for removing foreign bodies. The youngest patient was 9 month old and eldest 14 year old. The average age was 8.3 year old. The male female ratio was 2.4 storz tracheoscope ( Made in German ) was applied. Results Forty six of the 48 foreign bodies were removed through tracheoscope. The foreign bodies slipped off at the level of the glottis in 3 cases, they were then removed from the opposite bronchus (respiratory difficult syndrome developed in these cases); a thumbtack was removed by tracheotomy; one stone of apricot was removed through. Conclusions An accurate pre operative diagnosis is most important in operative management of cases of irregular shaped foreign bodies. General anesthesia, is usually. If the foreign body is too big to pass through the glottis, removing by tracheotomy should be considered.