小儿喉、气管、支气管异物221例临床分析

doi:10.6040/j.issn.1673-3770.0.2018.355

摘要/Abstract

摘要： 目的

总结小儿喉、气管、支气管异物的临床特点及诊治经验，提高该病的诊治水平。

方法

回顾性分析221例小儿喉、气管、支气管异物的临床资料,总结此类患者的发病年龄、主要临床症状和体征以及诊断、治疗方法。

结果

91.9%的患者年龄在3岁以内,而13~24个月患者比例高达61.1%；主要临床症状为刺激性咳嗽；主要体征为一肺呼吸音减低或双肺呼吸音不对称；肺CT定性诊断准确性为100%，定位诊断准确性为96.4%；异物吸入史阳性患者硬质支气管镜检查外源性异物阳性率高于阴性者（χ²=22.886，P＜0.001）；一肺呼吸音减低或双肺呼吸音不对称阳性患者硬质支气管镜检查外源性异物阳性率高于阴性者（χ²=3.905，P=0.048）；除5例患者在局麻或无麻下完成手术外，其余患者均在全麻直达喉镜或硬质支气管镜下完成异物取出。221例患儿中220例经不同方法取出异物后痊愈出院，1例患者死亡。

结论

结合异物吸入史、典型肺部体征及肺CT检查，可准确诊断小儿喉、气管、支气管异物。全麻下直达喉镜或硬质支气管镜异物取出术是治疗小儿喉、气管、支气管异物的有效方法。

关键词: 异物, 呼吸道, 儿童, 治疗结局

Abstract: Objective

To summarize the clinical characteristics, diagnosis, and treatment experience of laryngeal and tracheobronchial foreign body aspiration in children, and improve the approach to diagnosis and treatment of this condition.

Methods

Clinical data of 221 cases of laryngeal and tracheobronchial foreign body aspiration in children were retrospectively analyzed, and the pathogenesis in the patients with respect to age, main clinical symptoms and signs, and diagnostic and treatment considerations were summarized.

Results

In total, 91.9% of the patients were under three years of age, and the proportion of patients between 13 and 24 months was as high as 61.1%. The main clinical symptom was irritant cough, and the main clinical sign was a lung respiratory murmur or double lung respiratory tone asymmetry. The diagnostic accuracy of lung CT was 100%, and the accuracy of localization was 96.4%. The positive rate of exogenous foreign body removal by rigid bronchoscopy in patients with a history of foreign body inhalation was higher than that in patients without such a history (χ²=22.886，P＜0.001). These patients presented with lower respiratory sounds in one lung or asymmetric respiratory sounds in both lungs more often than those without the manifestations enumerated above（χ²=3.905，P=0.048）.In addition to five patients who underwent surgery under the administration of anesthesia or without anesthesia, the remaining patients had the foreign bodies removed by direct laryngoscopy or rigid bronchoscopy.

Conclusion

Combined with a history of foreign body inhalation, typical pulmonary signs, and lung CT examination results, laryngeal and tracheobronchial foreign bodies can be accurately diagnosed. The extraction of foreign bodies by direct laryngoscopy or rigid bronchoscopy under general anesthesia is an effective method to treat laryngeal and tracheobronchial foreign body aspirations.

Key words: Foreign body, Respiratory, Child, Treatment outcome

中图分类号:

R768.13

陈蔚华,张凯扬,郑晓彬. 小儿喉、气管、支气管异物221例临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 111-115.

Weihua CHEN,Kaiyang ZHANG,Xiaobin ZHENG. Foreign bodies in the throat and bronchi of children: a report of 221 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 111-115.

图/表 2

表1

表2

参考文献 15

1	张慧，黄秋玲，张维溪，等 . 674例儿童呼吸道异物的临床诊治分析［J］.温州医科大学学报，2017，47（12）：916-918.doi: 10.3969/j.issn.2095-9400.2017.12.014 . doi: 10.3969/j.issn.2095-9400.2017.12.014
	ZHANG Hui , HUANG Qiuling , ZHANG Weixiet al .Analysis of 674 cases of foreign bodies aspiration in the respiratory tract in children［J］.Journal of Wenzhou Medical University, 2017，47（12）：916-918.doi: 10.3969/j.issn.2095-9400.2017.12.014 . doi: 10.3969/j.issn.2095-9400.2017.12.014
2	Rodriguez H , Passali GC , Gregori D , et al . Management of foreign bodies in the airway and oesophagus［J］. Inter J Pedia Otorhinolaryngol, 2012,76(1):84-91.doi:10.1016/j.ijporl.2012.02.010 . doi: 10.1016/j.ijporl.2012.02.010
3	陈婉珍，李卫平，竺欣 .小儿气道异物现场急救的意义及方法［J］.中华急诊医学杂志，2003，12（1）：50-51.doi:10.3760/j.issn:1671-0282.2003.01.019 . doi: 10.3760/j.issn:1671-0282.2003.01.019
	CHEN Wanzhen ， LI Weiping ， ZHU Xin . Significance and method of emergency treatment of airway foreign body in children［J］.Chin J Emerg Med， 2003， 12（1）：50-51.doi:10.3760/j.issn:1671-0282.2003.01.019 doi: 10.3760/j.issn:1671-0282.2003.01.019
4	黄敏，赵斯君，吴雄辉，等 . 儿童呼吸道异物延迟诊断的相关因素分析［J］. 临床小儿外科杂志，2018，17（10）：778-782.doi：10.3969 ／j.issn.1671-6353.2018.10.012. doi: 10.3969
	HUANG Min , ZHAO Sijun , WU Xionghui , et al .Analysis of correlative factors of delayed of respiratory foreign body in children［J］. J Clin Ped Sur,2018, 17 10）：778-782.doi：10.3969 ／j.issn.1671-6353.2018.10.012. doi: 10.3969
5	杨枝芳，朱胜华 .儿童气管、支气管异物各临床特征的诊断价值研究［J］.医学临床研究,2017,34(6):1105-1108.doi:10.3969/j.issn.1671-7171.2017.06.020 . doi: 10.3969/j.issn.1671-7171. 2017. 06.020
	YANG Zhifang , ZHU Shenghua .Analysis of sensitivity and specificity of clinical features of tracheobronchial foreign body diagnosis in children［J］. J Clin Res, 2017,34(6):1105-1108.doi:10.3969/j.issn.1671-7171. 2017. 06.020 . doi: 10.3969/j.issn.1671-7171. 2017. 06.020
6	张杰 .儿童呼吸道异物致喘息的识别和处理［J］.中国小儿急救医学，2017，24（12）：883-887.doi:10. 3760 / cma. j. issn. 1673-4912. 2017. 12. 002 . doi: 10. 3760 / cma. j. issn. 1673-4912. 2017. 12. 002
	ZHANG Jie .Identification and management of wheezing caused by foreign body aspiration in children［J］.Chin Pediatr Emerg Med, 2017，24（12）：883-887.doi:10. 3760 / cma. j. issn. 1673-4912. 2017. 12. 002 . doi: 10. 3760 / cma. j. issn. 1673-4912. 2017. 12. 002
7	段效军，陈艳萍，仇君 .儿童气管支气管异物的临床特征分析［J］.中国当代儿科杂志,2014,16(4):410-413.doi: 10.7499/j.issn.1008-8830.2014.04.021 . doi: 10.7499/j.issn.1008-8830.2014.04.021
	DUAN Xiaojun , CHEN Yanping , QIU Jun .Clinical features of tracheobronchial foreign bodies in children［J］.Chin J Contemp Pediatr, 2014,16(4):410-413.doi: 10.7499/j.issn.1008-8830.2014.04.021 . doi: 10.7499/j.issn.1008-8830.2014.04.021
8	Hitter A , Hullo E , Durand C , et al . Diagnostic value of various investigations in children with suspected foreign body aspiration review［J］. Eur Ann Otorhinolaryngol Head Neck Dis, 2011,128(5):248-252.
9	倪鑫 .中国儿童气管支气管异物诊断与治疗专家共识［J］.中华耳鼻咽喉头颈外科杂志,2018,53(5):325-338.doi:10.3760/cma.j.issn.1673-0860.2018.05.002 . doi: 10.3760/cma.j.issn.1673-0860.2018.05.002
	NI Xin . Experts consensus on diagnosis and treatment of trachobronchial foreign bodies in children［J］.Chin J Otorhinolaryngol Head Neck Surg, 2018,53(5):325-338.doi:10.3760/cma.j.issn.1673-0860.2018.05.002 . doi: 10.3760/cma.j.issn.1673-0860.2018.05.002
11	张新海，胡伟，孙敏 .螺旋CT三维重建在气道异物定位诊断中的应用［J］.中国耳鼻咽喉颅底外科杂志,2014,20(4):352-353.doi: 10.11798/j.issn.1007-1520.2014-04017 . doi: 10.11798/j.issn.1007-1520.201404017
	ZHANG Xinhai , HU Wei , SUN Min .Application of spiral CTreconstruction in the diagnosis of airway foreign body localization［J］.Chin J Otorhinolaryngol Skull Base Surg, 2014,20(4):352-353.doi: 10.11798/j.issn.1007-1520.201404017 . doi: 10.11798/j.issn.1007-1520.201404017
12	高滢，王正辉，常会敏，等 .小儿气管支气管异物2000例［J］.山东大学耳鼻喉眼学报,2015,29(6):39-42.doi:10.6040/j.issn.1673-3770.0.2015.303 . doi: 10.6040/j.issn.1673-3770.0.2015.303
	GAO Ying , WANG Zhenghui , CHANG Huimin ,et al .Foreign bodies in children′s bronchus:an analysis of 2000 cases［J］.J Otolaryngol Ophthal Shandong Univ, 2015,29(6):39-42.doi:10.6040/j.issn.1673-3770.0.2015.303 . doi: 10.6040/j.issn.1673-3770.0.2015.303
13	王军，渠晓丽，杨庆文，等 .呼吸道复发性乳头状瘤患儿术中缺氧耐受的观察［J］.临床耳鼻咽喉头颈外科杂志,2011,25(6):250-254.
	WANG Jun , QU Xiaoli , YANG Qingwen ,et al .The hypoxia tolerance of children with recurrent respiratory papillomatosis in surgical procedures［J］.J Clin Otorhinolaryngol (Chin), 2011, 25(6):250-254.
14	王素芳，韩富根，成怡冰，等 .小儿呼吸道异物术前发生急性呼吸功能不全的危险因素分析［J］.中华耳鼻咽喉头颈外科杂志,2014,49(11):925-929.doi:10.3760/cma.j.issn.1673-0860.2014.11.011 . doi: 10.3760/cma.j.issn.1673-0860.2014.11.011
	WANG Sufang , HAN Fugen , CHENG Yibing ,et al .Risk factors of acute respiratory dysfunction in children with airway foreign body［J］.Chin J Otorhinolaryngol Head Neck Surg, 2014,49(11):925-929. doi:10.3760/cma.j.issn.1673-0860.2014.11.011 . doi: 10.3760/cma.j.issn.1673-0860.2014.11.011
15	温鑫，苏金柱，王娟 .支气管异物术后炎性肉芽肿2例［J］.山东大学耳鼻喉眼学报,2016,30(4):113-114.doi：10.6040 ／j.issn.1673-3770.0.2015.467. doi: 10.6040
	WEN Xin , SU Jinzhu , WANG Juan .Inflammatory granuloma after bronchial foreign body surgery in 2 cases［J］. J Otolaryngol Ophthal Shandong Univ, 2016,30(4):113-114. doi：10.6040 ／j.issn.1673-3770.0.2015. 467. doi: 10.6040

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异物位置	支气管镜检查	CT定性诊断	CT定位诊断
左支气管	82	82	82
右支气管	80	80	76
双支气管	5	5	4
气管	41	41	40
声门	4	4	4
气管+左支气管	3	3	3
气管+右支气管	3	3	2
气管+双支气管	2	2	1
合计	220	220	212
准确性（%）	100.0	100.0	96.4

检测项目	支气管镜检查（例）	外源性异物存留阳性率（%）	χ²	P
检测项目	阳性阴性	外源性异物存留阳性率（%）	χ²	P
异物吸入史
阳性	194 3	98.5	22.866	＜0.001
阴性	19 5	79.2
一肺呼吸音减低或双肺呼吸音不对称
一肺呼吸音减低或双肺呼吸音不对称
阳性	169 4	97.7	3.905	0.048
阴性	44 4	91.7
刺激性咳嗽
阳性	210 7	96.8	0.921	0.337
阴性	3 1	75.0