小儿双侧支气管异物40例临床特点及治疗分析

Clinical manifestation and management of bilateral bronchial foreign body aspiration in children

目的总结儿童双侧支气管异物的临床表现和治疗。方法回顾分析40例双侧支气管异物患儿的临床资料,包括临床表现、影像学检查、术中所见及并发症。结果 40例患儿均有明确异物吸入史。主诉阵发性咳嗽38例、喘息40例、阵发性呼吸困难5例。体格检查:双肺呼吸音减低16例、单侧呼吸音减低24例、呼吸困难22例。25例患者术前行肺部仿真CT,提示双侧支气管异常密度灶16例;9例患者胸部X线片提示双侧支气管内病变2例;6例无影像学资料。CT与术中情况的符合度高于胸部X线片(χ~2=4.636,P<0.05)。患儿均行硬质支气管镜下异物取出术,3例经历2次以上手术,无死亡病例。术中血氧饱和度<80%者31例、心率下降2例、出血2例、术后拔管困难3例。异物位置:左主支气管、右主支气管(左1右1)16例,左肺叶支气管、右主支气管(左2右1)8例,9例为左2右2,7例为左1右2。不同异物位置组术前呼吸困难的发生率差异有统计学意义(χ~2=15.9,P<0.05)。结论阵发性咳嗽、喘息、伴阵发性呼吸困难是小儿双侧支气管异物的主要临床表现。异物位置与术前呼吸困难紧密相关,合并呼吸困难提示至少有一侧异物位于主支气管。尽早行硬质支气管镜检术是其安全救治措施。

Objective To explore the clinical manifestation and management of bilateral bronchial foreign body aspiration in children. Methods This retrospective study included 40 patients with bilateral foreign body aspiration according to rigid bronchoscopy. The clinical manifestations,radiological findings,bronchoscopic findings and complications of the procedure were analyzed. Results There was a definite history of foreign body aspiration in all cases. The symptoms included paroxysmal cough（ 38 cases）,wheezing（ 40cases） and paroxysmal respiratory distress（ 5 cases）. Signs included bilateral decreased breath sound（ 16 cases）,unilateral decreased breath sound（ 24 cases） and dyspnea（ 22 cases）. Twenty-five patients had computer tomography（ CT） in which 16 were found to have bilateral bronchi abnormalities,and 9 had chest X-ray in which 2 were found to have bilateral bronchus abnormalities in 2 cases. Six patients had no pre-operative imageology. A statistically significant difference was detected with respect to imageology and intraoperative conformity between CT and chest X-ray（ χ^2= 4. 636,P〈0. 05）. All patients had a successful removal of the foreign bodies with rigid bronchoscopy,3 of which underwent twice or more surgeries. There were no death happened. Complications included the intraoperative oxygen satuation less than 80%（ 31 cases）,bradycardia secondary to hypoxia（ 2 cases）,bleeding of mucosa（ 2 cases） and extubation failure（ 3 cases）. Foreign bodies were found located in bilateral main bronchus in 16 cases（ 40%）,left lobar bronchi and right main bronchus in 8 cases（ 20%）,bilateral lobar bronchi in 9 cases（ 22. 5%）,left main bronchus and right lobar bronchi in 7 cases（ 17. 5%）. A statistically significant difference was detected with respect to locations of the foreign bodies for dyspnea（ χ^2= 15. 9,P〈0. 05）. Conclusions Paroxysmal cough and wheezing with paroxysmal dyspnea were the most common clinical symptoms in children with bilateral bronchial foreign bodies. Location of the foreign bodies was the risk factor for dyspnea. Rigid bronchoscopy was the most important treatment. Prompt diagnosis and intraoperative removal of the foreign body as soon as possible are the key factors for success.