儿童异物吸入的诊治和预防  

Management and prevention of foreign body aspiration in children

作　　者：许煊[1] 祝彬[1] 石苗茜[1] 任海丽[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院儿童重症科,100700

出　　处：《中华实用儿科临床杂志》2015年第18期1383-1386,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：“十二五”国家科技支撑计划项目（2012BA04801）

摘　　要：目的：提出儿童异物吸入的预防建议,探讨软式支气管镜（ FB）在儿童气管支气管异物诊断及治疗中的有效性、安全性及应用经验。方法回顾性总结2013年1月至2014年12月北京军区总医院附属八一儿童医院对38例呼吸道异物在FB下取出,并对出现肉芽组织增生的患儿进行氩气刀（ APC）联合二氧化碳（ CO2）冷冻治疗经验,分析患儿临床资料,包括年龄、性别、吸入异物至就诊的时间、临床及X线表现、异物所在位置、支气管镜与 APC 及冷冻治疗、并发症和结局情况。结果38例患儿中男31例（81.6%）,女7例（18.4%）；年龄10个月~14岁,平均年龄28.5个月；有明确异物史30例（78.9%）。最常见临床症状为呛咳（84.3%）；X 线胸片示15例表现为患侧肺不张（39.5%）,肺气肿17例（44.7%）,肺炎改变6例（15.8%）,11例来院时行肺部CT检查,仅1例见有异物影；镜检发现吸入的异物位于右侧支气管22例（57.9%）,花生米是本组患儿吸入的主要异物；仅4例（10.5%）在异物吸入24 h内诊明确诊断并取出异物,34例（89.5%）于异物吸入24 h 后才明确诊断及治疗；儿童哭闹是导致异物吸入的首要诱因。38例患儿吸入异物全部在FB下取出。有19例（50.0%）在异物周围有肉芽组织增生,其中5例异物被增生的肉芽组织包裹,用APC处理异物表面的肉芽组织暴露异物后取出,然后予CO2冷冻治疗；9例异物周围有肉芽组织但未形成包裹,取出异物后直接予CO2冷冻治疗。本组1例术中有心动过缓,2例术后少量出血,无相关性死亡病例。结论对3岁以下的婴幼儿父母进行饮食习惯及喂养方法的教育是预防婴幼儿异物吸入的关键,FB下可安全取出呼吸道异物且并发症少,是异物吸入呼吸道诊断及治疗的可选方法之一。Objective To put forward the prevention advice on foreign body suction,and to discuss the effica-cy,safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bron-choscopy and granulation tissue proliferation in Argon plasma coagulation （ APC ） （ argon knife ） combining carbon dioxide（ CO2 ） cryotherapy in Bayi Children′s Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed,and the clinical data including age,gender,treatment time for inhaled foreign body,clinical and X-ray manifestations,location of the foreign body,treatment with bronchoscopy with APC and cryotherapy,complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male （81. 6%） and 7 female（18. 4%）,aged from 10 months to 14 years old,with mean age 28. 5 months;among them there were 30 cases with definite history of foreign body,accounting for 78. 9%;the most common clinical symptom was cough among the cases,accounting for 84. 3%;X ray showed 15 cases with ipsilateral lung atelectasis,accounting for 39. 5%, emphysema in 17 cases,accounting for 44. 7%,pneumonia change in 6 cases,accounting for 15. 8%,there were 11 ca-ses who had lung computerized tomography examination when coming to the hospital,and only 1 case could be seen to have foreign body shadow;microscopic examination found that inhaled foreign body in the right bronchus accounted for 57. 9%,and peanut was the main foreign body inhalation in this group;only 4 cases（10. 5%） had definite diagnosis and foreign body removal within 24 h after foreign body aspiration,moreover,34 cases（89. 5%） with foreign body aspi-ration got the diagnosis and treatment after 24 h;crying was the primary inducement for inhaled foreign body. All the 38 cases of children with inhaled foreign body experienced removal under f

关 键 词：软式支气管镜 气管支气管异物 氩等离子体凝固 冷冻技术 肉芽组织 儿童 

分 类 号：R768.4[医药卫生—耳鼻咽喉科]