儿童气管支气管异物临床诊治探讨  

Study on the clinical diagnosis and treatment for tracheobronchus foreign bodies in children.

作　　者：江沁波[1] 刘玺诚[1] 江载芳[1] 

机构地区：[1]首都医科大学附属儿童医院,北京100045

出　　处：《中国实用儿科杂志》2004年第12期734-737,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的　探讨儿童气道不同部位异物的临床特征、诊治方法及应用硬气管镜、纤维支气管镜或开胸等治疗方法的最佳时机。方法　回顾性总结首都医科大学附属儿童医院纤维支气管镜 (纤支镜 )室 1990年 12月至 2 0 0 3年 12月间诊治的下气道异物临床资料 ;应用纤支镜对硬气管镜难以取出、又无开胸指征的气道异物进行治疗 ;追踪临床转归。结果　经纤支镜诊断下气道异物 192例 ,位于Ⅱ级以下支气管 15 9例 ;年龄 12d至 14岁 ;病程 4h至 8年 ,3d内仅 2 4例。食物性异物 14 6例 ,小塑料制品异物 2 2例 ,仅 18例可通过X线检查确诊异物。临床特点 :4 5例无确切异物史 ,4 1例有反复呼吸道感染 ,5例因植物性及硬果壳类异物致咯血 ,滞留达 7个月至 3年。X线表现 :肺炎 113例 (5 8 9% ) ,肺不张 5 0例 (2 6 0 % ) ,肺透光增强及支气管阻塞征各 37例(19 3% ) ,纵隔摆动或心影反常大小 2 8例 (14 6 % ) ,胸膜炎或胸腔积液 12例 (6 3% ) ,异物远端支气管扩张 7例(3 6 % ) ,2 5例 (13 0 % )X线正常。转归 :取出异物 175例 :开胸 14例 (其中 6例病肺叶、段切除 ) ;硬气管镜取异物 4 7例 5 6次 (3例未取出 ) ;纤支镜取 118例并灌洗吸入性肺炎 14例 ,共 380次。治愈 14 9例 ,好转 4 1例 ,2例未愈。结论　支气管异物临床过程不?Objective To explore the clinical characteristics,diagnosis and treatment for airway foreign bodies in children.To explore the best time for intervention treatment.Methods We retrospectively summarized the data about airway foreign bodies that diagnosed by fiber bronchoscopy in Beijing Children's Hospital between 1990.12～2003.12.Fibrobronchoscopy was applied to the airway foreign bodies unable to be removed with rigid tracheoscope,fiberbronchoscope or by thoracotomy.Results There were 192 airway foreign bodies diagnosed by fiber bronchoscopy.Ages:12 days 14 years; course:4 hours 8 years.159 (more than 80%) airway foreign bodies were located under ⅡorⅢ grade bronchus.Alimentary foreign bodies were 146 cases (nearly 80%),plastic foreign bodies were 22 cases ( 11.5%) and only 18 cases ( 3.6%) metal foreign bodies were discoverd by X ray.Bronchus foreign bodys in X ray presentted as pneumonia (113 cases;58.9%),atelectatic(50 cases;26.0%),block signal in bronchus (37 cases;19.3%) and pleural thickening were 12 cases (6.3%),bronchiectasis after bronchus foreign bodies were 7 cases ( 3.6%) and honeycomb lung were 2 cases.The foreign bodies were enucleated in 175(14 were enucleated by opening chest and 6 of them were peumectomy; 46 were enucleated with rigid tracheoscopy and with fiber bronchoscopy in 118.They were healed in 149 and improved in 41,but none of them died.Conclusion Bronchus foreign bodies isone of the pathogeny in chronic reactive respiratory diseases and they are discovered by fiber bronchoscopy.fiberbronchoscope plays an important role in the diagnosis and treatment.

关 键 词：气管支气管异物 纤维支气管镜 儿童 

分 类 号：R72[医药卫生—儿科]