人工鼻海绵误吸导致气道异物1例  

Airway foreign body caused by aspiration of artificial nasal sponge: a case report

作　　者：符天旭 王玺[2] 刘梅林[1] FU Tian-xu;WANG Xi;LIU Mei-lin(Department of Geriatrics,Peking University First Hospital,Beijing 100034,China;Department of Respiratory,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院老年病内科,北京100034 [2]北京大学第一医院呼吸内科,北京100034

出　　处：《北京大学学报（医学版）》2018年第2期375-377,共3页Journal of Peking University:Health Sciences

摘　　要：1病例资料患者男性,57岁,主因“头痛、发作性抽搐14天”于2015年11月6日入住我院神经内科病房。患者入院14天前以咽痛起病,后逐渐出现头痛、左面肌不自主抽动,于当地医院抗感染治疗无好转,10天前出现抽搐、四肢强直、意识丧失,持续5 min后意识恢复,但之后出现神志淡漠、行为异常,于我院神经内科门诊就诊时再发抽搐伴喷射样呕吐,经急诊转入神经内科进一步治疗。既往有2型糖尿病病史,口服二甲双胍,血糖控制欠佳,否认手术、外伤史,否认毒物、放射物接触史。入院体格检查:血压130/85 mmHg(1 mmHg=0.133 kPa),心率81次/min,神志清楚,表情淡漠,反应迟钝,感觉性失语,定向力完整,理解力、计算力、记忆力减退,无明确神经系统定位体征。完善相关影像学及脑脊液检查后,诊断为病毒性脑炎、症状性癫痫、2型糖尿病,给予患者抗病毒、抗感染、降颅压、镇静、营养支持等对症治疗,患者抽搐次数逐渐减少,但意识始终未恢复,呈昏睡状态。此后,因患者持续意识障碍,自主咳嗽、咳痰能力弱,反复出现痰堵,氧合指数下降,且存在胃内容物反流,2015年12月19日于呼吸内科重症监护室请耳鼻喉科医师床旁局部麻醉下行气管切开术,术后维持人工鼻吸氧3 L/min,血氧饱和度(blood oxygen saturation,SpO2)维持于99%~100%。SUMMARY A 57-year-old male was admitted to hospital for severe headache and seizure attacks on November 6th,2016.After radiology and spinal fluid examination,he was diagnosed with viral encephalitis and treated with antiviral medicine,antibiotics and mannitol,but he was in sustained unconsciousness and weak in expectorating.The patient was given oxygen through artificial nasal after bedside tracheotomy.At 1:00 am on January 12th,2016,there was a sudden drop in blood pressure,heart rate and oxygen saturation with left lung breath sounds slightly lower than the other side.The patient was connected to a ventilator with tidal volume of 300-500 mL and airway pressure of 16-24 cmH2O(1 cmH2O=0.098 kPa).In the meanwhile,the left side sponge of artificial nasal was found missing.Bedside chest X-ray showed no significant atelectasis.At that time the evidence of airway foreign body aspiration was not sufficient,so no urgent bronchoscopy was performed.At 9:00 am on January 14th,2016,there was another sudden decline in oxygen saturation with diminished left lung breath sounds and decreased left thoracic activity.Since left atelectasis could not be ruled out,bedside bronchoscopy was performed.In the operation,two sponge-like objects were found at the left main bronchus and the opening of left upper lobe bronchial.Foreign body forceps were used to remove them.The foreign bodies were proved to be the left sponge of artificial nasal afterwards.Symptoms and signs caused by aspiration of foreign body in adults were widely various and depending on the nature of the foreign body,site,time and whether there was infection or not.Foreign body aspiration caused by artificial nasal sponge was rare in clinical practice.This case was a living reminder to perform bronchoscopy when foreign body aspiration was suspected.For the unconscious and elderly patient,whose history of foreign body aspiration usually could not be clearly provided,when atelectasis was suspected,bronchoscopy should be performed progressively,and more effective measures sh

关 键 词：支气管 异物 气道阻塞 支气管镜检查 误吸 

分 类 号：R768.4[医药卫生—耳鼻咽喉科]