儿童支气管异物临床特征及误诊分析

Clinical Characteristics and Misdiagnosis of Bronchial Foreign Body in Children

目的 总结儿童支气管异物的临床特征及误诊原因。方法 回顾性分析2017年10月—2022年10月收治73例儿童支气管异物误诊病例的临床资料。结果 本组73例均有反复咳嗽、咳痰症状;其中发热34例,喘息39例,严重呼吸困难3例;所有患儿无咯血症状。56例未提供异物吸入史,而其余17例可能有异物吸入史。误诊为以肺炎为主的呼吸道感染59例、支气管哮喘或咳嗽变异性哮喘10例、急性喉炎并喉梗阻4例,均反复给予针对性治疗无明显好转。误诊时间8 d~3个月。所有病例经病史采集、实验室检查、影像学检查、电子支气管镜检查后确诊为支气管异物,电子支气管镜检查的同时将异物取出,手术成功率为100%,且无手术并发症。术后72例联合抗感染治疗,症状体征消失,影像学基本恢复正常,达到临床治愈;1例因脑部缺氧术后一直处于昏迷状态,家长放弃治疗。本组治愈率98.6%。结论 由于无法有效采集病史,儿童支气管异物容易被漏诊、误诊,从而延误治疗,对反复咳嗽、喘息常规治疗无效,听诊发现异常呼吸音的患儿应反复询问有无异物吸入史,并尽早完善胸部CT检查,必要时行电子支气管镜检查,确诊后绝大部分异物可经电子支气管镜安全取出,该病治愈率高,手术并发症低。

Objective To summarize the clinical features and causes of misdiagnosis of bronchial foreign body in children.Methods Clinical data of 73 children with misdiagnosed bronchial foreign body admitted from October 2017 to October 2022 were retrospectively analyzed.Results All 73 cases in this group had recurrent cough and expectoration symptoms,including 34 with fever.There were 39 cases of wheezing and 3 cases of severe dyspnea.All the children had no symptoms of hemoptysis.Fifty-six cases did not provide a history of foreign body inhalation,while the remaining 17 cases might have a history of foreign body inhalation.Of them,there were 59 cases misdiagnosed as respiratory tract infection,mainly pneumonia,10 cases as bronchial asthma or cough variant asthma,and 4 cases as acute laryngitis and laryngeal obstruction,all of which failed to improve significantly after repeated targeted treatment.Misdiagnosis lasted from 8 d to 3 months.All cases were diagnosed as bronchial foreign body after history collection,laboratory examination,imaging examination,and electronic bronchoscopy.The foreign bodies were removed during electronic bronchoscopy.The success rate of surgery was 100%,and there were no surgical complications.After operation,72 patients were treated with combined anti-infection therapy;the symptoms and signs disappeared,and imaging results basically returned to normal,achieving clinical cure.One patient remained in a coma after surgery due to cerebral hypoxia,and the parents gave up treatment.The cure rate of this group was 98.6%.Conclusion Due to the inability to effectively collect medical history,bronchial foreign body in children is more likely to be missed and misdiagnosed,thus delaying the treatment.For children with repeated cough and wheezing after ineffective conventional treatment,and children with abnormal breathing sounds found by stethoscope,it is necessary to repeatedly ask whether there is a history of foreign body inhalation,improve chest CT examination as soon as possible,and perform electronic bronchoscopy if necessary.After diagnosis,most foreign bodies can be safely removed by electronic bronchoscope.The cure rate of the disease is high and surgical complications are low.