气道异物患儿临床特征及抗菌药物应用时机分析

Clinical characteristics of children with airway foreign bodies and timing of antimicrobial application

目的分析儿童气道异物的临床特征及异物引起肺部细菌性感染的相关因素,探讨异物患儿抗菌药物应用的时机。方法回顾性分析滨州医学院附属医院2016年1月至2021年1月行支气管镜诊断和治疗173例气道异物患儿的临床资料、异物种类、异物嵌顿部位、异物残留时间、支气管镜下表现、血液学检查、肺泡灌洗液呼吸道13项病原学检测。结果发生气道异物患儿平均年龄1.64岁,其中1~2岁占77.0%,病程为1.5 h~4月。主要的异物种类为植物性异物161例(93.1%)。异物嵌顿部位以右侧多见(54.9%),右侧又以右主支气管及右中间段支气管多见。气道异物患儿血常规显示白细胞在正常参考值范围158例(91.3%);中性粒细胞绝对值在正常参考值范围162例(93.6%);C反应蛋白(CRP)在正常参考值范围154例(89.0%);降钙素原(PCT)在正常参考值范围者164例(94.8%)。异物引起的黏膜及气道炎症改变主要有肉芽增生113例、坏死黏膜附着111例、条絮状分泌物85例、稀薄分泌物99例。肺泡灌洗液呼吸道13项病原学检测共有45例(26.0%)患儿检测出存在病原体感染,共检出9种病原体。单因素分析显示年龄、异物残留时间与肺部细菌性感染有相关性,年龄<1岁发生细菌感染的危险性更大,且异物残留时间≥108 h时,提示可能合并肺部细菌性感染。结论气道异物多发于1~2岁患儿,以植物性异物为主,异物可引起气道内肉芽增生、黏膜坏死及絮状分泌物;大多无细菌感染,不能仅参考血常规、CRP、PCT对异物患儿进行抗菌治疗;年龄越小发生细菌感染机会越高;对于异物残留时间超过108 h的患儿尽早给予抗菌治疗。

Objective To analyze the clinical characteristics of children with airway foreign bodies and the related factors of pulmonary bacterial infection caused by foreign bodies,and to explore the application time of antibiotics in children with foreign bodies.Methods The clinical data of 173 children with airway foreign bodies diagnosed and treated by bronchoscopy in Binzhou Medical University Hospital from January 2016 to January 2021 were analyzed retrospectively,including the types of foreign bodies,the locations of foreign body incarceration,the residual time of foreign bodies,bronchoscopic manifestations,hematological examination,and 13 pathogenictests of alveolar lavage fluid in the respiratory tract.Results The average age of children with airway foreign bodies was 1.64 years old,of which 77.0%were between 1 and 2 years old.The course of disease was 1.5 hours to 4 months.The main types of foreign bodies were 161 cases of plant foreign bodies(93.1%).The right side(54.9%)was the most common site of foreign body incarceration,and the right main bronchus and right middle bronchus were more common on the right side.The blood routine of children with airway foreign bodies showed that the number of leukocytes were in the normal reference range in 158 cases(91.3%);the absolute value of neutrophils was within the normal reference range in 162 cases(93.6%);C-reactive protein(CRP)was in the normal range in 154 cases(89.0%);procalcitoninwas in the normal range in 164 cases(94.8%).The inflammatory changes of mucosa and airway caused by foreign bodies mainly included granulation hyperplasia in 113 cases,necrotic mucosal adhesion in 111 cases,strip flocculent secretion in 85 cases and sparse secretion in 99 cases.Detection of 13 pathogens of respiratory tract in alveolar lavage fluid showed that 45 cases(26.0%)were found to have pathogen infection,and a total of 9 pathogens were detected.Univariate analysis showed that age and foreign body residual time were correlated with pulmonary bacterial infection.The risk of bacterial infection was greater at the age of below 1 year old,and when the time of foreign body residue was 108hours and above,suggesting the possibility of pulmonary bacterial infection.Conclusion Airway foreign bodies are more common in children aged 1 to 2 years old,mainly vegetative foreign bodies,and they can cause granulation hyperplasia,mucosal necrosis and flocculent secretions in the airway.Most of them have no bacterial infection,so antibacterial treatment cannot be carried out only by referring to blood routine,CRP and PCT.The younger the age,the higher the chance of bacterial infection.For children with foreign body residual time more than 108 hours,antibacterial treatment should be given as soon as possible.