儿童下呼吸道异物合并阻塞性肺不张62例临床分析  

Clinical analysis of tracheobronchial foreign bodies combined with atelectasis in children

作　　者：张慧[1] 张维溪[1] 项海杰[2] 陈如如 李昌崇[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿科,325027 [2]温州医科大学附属第二医院育英儿童医院耳鼻喉科,325027

出　　处：《中华全科医师杂志》2017年第11期893-896,共4页Chinese Journal of General Practitioners

摘　　要：为探讨儿童下呼吸道异物合并阻塞性肺不张的临床特点,对2007年1月至2016年12月温州医科大学附属第二医院育英儿童医院收治的62例下呼吸道异物合并阻塞性肺不张患儿的临床资料进行回顾性分析.患儿年龄9个月至10岁2个月,病程6 h-4个月.植物性异物55例（88.71%）,动物性异物3例（4.84%）,化学成品异物4例（6.45%）.治愈60例,死亡2例.1例患儿术前死亡,其余61例患儿中,47例（77.05%）在全麻下经硬支气管镜一次完全取出异物,1例（1.64%）两次完全取出异物,10例（16.39%）经纤维支气管镜取出,3例（4.92%）行开胸手术取出,其中1例切除不张伴实变肺叶,1例术后出现严重复张性肺水肿死亡.儿童支气管异物合并阻塞性肺不张病情严重,术后可并发复张性肺水肿,死亡率高,需引起临床医生重视.Clinical data of 62 cases of tracheobronchial foreign bodies with pulmonary atelectasis admitted in Second Affiliated Hospital and Yuying Children′s Hospital during January 2007 to December 2016 were retrospectively analyzed .There were 40 boys and 22 girls aged 9 months to 10 years, and the symptom onset ranged from 6 hours to 4 months prior to medical intervention .The foreign bodies were vegetables in 55 （88.71%）, pieces of meat in 3 （4.84%） and chemical product in 4 cases （6.45%）. Sixty patients recovered after medical intervention , 1 died preoperatively and 1 died of severe reexpansion pulmonary edema （ RPE） .The foreign bodies were successfully removed with rigid bronchoscopy in a single attempt in 47 children （77.05%）, 1 child （1.64%） required two attempts to completely remove the foreign bodies;10 children （ 16.39%） were treated with fiberoptic bronchoscopy;3 children （ 4.92%） received thoracotomy , in which 1 child （ 1.64%） received a lobectomy due to pulmonary atelectasis and lung consolidation during operation .Conclusion Foreign bodies combined with pulmonary atelectasis in children are likely to be misdiagnosed , which led to severe adverse events . RPE is a serious postoperative complication of children receiving rigid bronchoscopy as a treatment , especially those diagnosed with tracheobronchial foreign bodies combined with pulmonary atelectasis .

关 键 词：儿童 异物 肺不张 支气管镜检查 

分 类 号：R725.6[医药卫生—儿科]