老年患者下呼吸道异物的临床特点分析

Analysis of clinical characteristics of foreign bodies in the lower respiratory tract in geriatric patients

目的:总结及分析老年患者下呼吸道异物的临床特点,总结支气管镜检查对老年患者下呼吸道异物确诊和治疗方法及效果。方法:收集首都医科大学附属北京友谊医院2015年1月至2023年6月诊治的28例60岁以上老年下呼吸道异物患者的临床资料进行回顾分析。结果:共计收治经支气管镜或手术确诊下呼吸道异物患者28例,男性17例,女性11例;年龄60~91岁,平均年龄70.8岁;共计27例患者完善支气管镜检查并确诊为气道异物,26例成功使用不同方法对异物进行取出,无严重并发症发生。异物位于主气管1例,位于左侧支气管3例,位于右侧支气管24例。异物类型辣椒8例,豆类8例,骨头6例,牙齿2例,苹果、枣核、麦穗、硬币各1例。按是否在行气管镜或手术前临床诊断气道异物分为诊断组和误诊组两组。诊断组共8例,误诊组共20例。两组患者在年龄、性别、既往史等均无明显差异。两组患者除异物吸入史有明显差异外,咳嗽、咳痰、咳血、发热以及喘憋症状和三凹征、干啰音、湿啰音以及呼吸音减低等体征均无明显差异。诊断组平均发病时间[2.7(0.3,12.5) vs. 60.0(60.0, 202.5)天,P=0.005]、平均住院时间[11.5(11.0,12.75)vs. 14.0(13.25,15.0)天,P=0.014]均明显低于误诊组患者。平均诊疗费用[1.1(0.5, 2.6) vs.1.4(1.2,1.7)万元,P=0.136]也低于误诊组,但差异无统计学意义。结论:老年患者气道异物症状不典型,异物吸入史对老年患者气道异物诊断具有重要价值。部分老年人异物吸入史不易确定,易误诊为其他呼吸系统疾病,尤其不明原因肺炎以及气道狭窄或者气道阻塞的老年患者,应及时行胸部CT和支气管镜检查以明确气道异物的诊断。以减少诊疗时间、住院时间和诊疗费用。

Objective:To summarize the clinical characteristics of foreign bodies in the lower respiratory tract in the elderly,and to evaluate the value of bronchoscopy in the diagnosis and treatment of foreign bodies in the lower respiratory tract.Methods:Clinical data of aged patients over 60 years old with foreign bodies in lower respiratory tract were analyzed retrospectively,which was diagnosed and treated by Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to June 2023.Results:A total of 28 cases were admitted,17 were males and 11 were females;Age range 60 to 91 years old,mean age 70.8 years old;27 patients were identified as foreign bodies by routine bronchoscopy,26 patients were successfully removed by different methods,and no serious complications occurred.Foreign bodies were located in the main trachea in 1 case,in the left bronchus in 3 cases,and in the right bronchus in 24 cases.Foreign body types:pepper(8 cases),beans(8 cases),bone(6 cases),tooth(2 cases),apple(1 case),Chinese-date pit(1 case),ear of wheat(1 case),and coin(1 case).They were divided into two groups according to whether they had a history of foreign body inhalation.According to whether the diagnosis of foreign bodies was built before bronchoscopy or surgery,it was divided into diagnostic group or misdiagnosis group.There were 8 patients in the diagnostic group and 20 cases in the other group.There were no significant differences in age,gender,or past history between the two groups.Except for significant differences in the history of foreign body inhalation,cough,sputum,cough,blood,fever,asthma,and symptoms,dry rales,wet rales and reduced breath sounds also have no differences.The mean time of onset in the diagnostic group[2.7(0.3,12.5)vs.60.0(60.0,202.5)days,P=0.005],and average hospitalization days,[11.5(11.0,12.75)vs.14.0(13.25,15.0)days,P=0.014],were significantly lower than those of patients in the misdiagnosed group.The mean medical cost[1.1(0.5,2.6)vs.1.4(1.2,1.7)thousands,P=0.136],was also lower than the misdiagnosed group,but the difference was not statistically significant.Conclusions:Symptoms in elderly patients of airway foreign body are atypical,and the history of foreign body inhalation has great value for the diagnosis of airway foreign body in elderly patients.The history of foreign body inhalation in some elderly people is not easy to determine,and it is easily misdiagnosed as other respiratory diseases,especially for elderly patients with pneumonia of unknown cause and airway stenosis or airway obstruction,CT and bronchoscopy should be performed in time to clarify the diagnosis of airway foreign body.To reduce the treatment time,hospital stay and treatment costs.