小儿气管支气管异物312例

A clinical analysis of 312 cases of children bronchial foreign bodies

目的总结小儿气管支气管异物的诊断、治疗及围手术期并发症防治方面的经验,提高诊治水平,降低围手术期并发症的发生。方法回顾性分析以气管支气管异物收住院312例的病历资料,其中有1例张开的别针和1例大头针异物因位置特殊转外院胸科开胸取出,7例术前将异物咳出,8例病情危急在无麻下直接取出异物,其余均在全身麻醉下用硬质支气管镜取出异物。结果 312例中支气管异物左侧123例,右侧129例;气管60例。其中异物取出后麻醉苏醒期出现窒息26例,经面罩加压给氧抢救后好转;苏醒回病房后出现窒息1例,回手术室再次支气管镜下取出遗留部分异物后好转;术后考虑脑水肿转综合医院小儿科1例,治疗好转;因窒息时间太长,到医院后抢救无效死亡1例;其余病例均手术顺利,恢复好。结论气管支气管异物发病以男性多见,以1岁左右年龄段高发,异物种类以花生和瓜子最多,异物位置左右支气管无明显差异,术前及时明确诊断、术中仔细操作及术后严密观察是降低围手术期并发症的关键。

Objective To investigate the diagnosis,treatment and management of perioperative complications in the pa-tients with tracheobronchial foreign bodies.Methods Clinical data of 312 cases of bronchial foreign body were ana-lyzed retrospectively.Among them,two pin cases underwent thoracotomy,and 7 cases coughed out the foreign bodies by themselves.Though 8 cases were treated without anesthesia due to critical conditions,the others received rigid bron-choscopy to remove the foreign bodes under general anesthesia.Results In 312 cases,the foreign bodies were located on the left in 123 cases and on the right in 129 cases.The remaining were found in trachea.During the the removal of foreign bodies,26 cases presented asphyxia in the wakening from the anesthesia and recovered well with the pressurized oxygen mask.One patient presented asphyxia in the ward,and was transfered immediately back to the operation room to remove the remnants of foreign body.Except one case of brain edema died eventually,the others were successful dis-charged.Conclusion The tracheobronchial foreign bodies are usually occurred in boys with the peak age at one year old.Although the foreign bodies are various,peanuts and melon seeds are much common.There are no significance difference between the left and right bronchus.Timely diagnosis,careful operation and close observation are the keys to avoid and reduce the perioperative complications.