儿童呼吸道异物延迟诊断的相关因素分析  

Analysis of correlative factors of delayed diagnosis of respiratory foreign body in children

作　　者：黄敏[1] 赵斯君[1] 吴雄辉[1] 李贇[1] 陶礼华[1] 赵伟亮 Huang Min;Zhao Sijun;Wu Xionghui;Li Yun;Tao Lihua;Zhao Weiliang(Department of Otorhinolaryngology-Head&Neck Surgery,Hunan Children s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院耳鼻咽喉头颈外科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2018年第10期59-63,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省卫生厅一般项目(编号:B2015-123);湖南省科技厅项目(编号:2016ZK3025)

摘　　要：目的比较本院早期诊断和晚期诊断呼吸道异物患儿在地域、就诊次数、治疗情况、异物类型、部位等方面的差异,探讨呼吸道异物延迟诊断的相关因素。方法回顾性收集湖南省儿童医院收治的3 492例呼吸道异物患儿为研究对象,按确诊时间是否在24 h内分为早期诊断组(n=662)和晚期诊断组(n=2 830),比较分析两组患儿地域、异物误呛史、异物类型、停留部位、就诊次数及就诊情况等相关因素。结果 22. 23%的城市患儿与17. 54%的农村患儿在24 h内确诊,不同地区早期诊断的比例存在差异(χ~2=10. 583,P <0. 05)。61. 02%的金属类异物早期能被确诊,仅有17. 60%植物类异物被早期确诊,不同异物类型早期诊断的比例存在差异(χ~2=104. 025,P <0. 05)。40. 82%的喉部异物患儿能在异物呛入24 h内得到早期诊断,而气管异物与支气管异物患儿在24 h内早期诊断的比例分别占37. 77%和14. 60%,不同部位异物早期诊断的比例存在差异(χ~2=188. 773,P <0. 05)。早期诊断组中就诊1次的患儿占89. 12%,晚期诊断组中,就诊1次者占31. 13%,就诊2～3次者占54. 73%,就诊次数> 3次者占14. 13%,不同就诊次数早期诊断的比例存在差异(χ~2=741. 310,P <0. 05)。非一次性确诊的患儿在确诊前均被按呼吸道感染性疾病和喘息性疾病反复治疗。结论呼吸道异物延迟诊断可能与不同地区、异物类型、异物停留部位和就诊次数有关;易被误诊为肺炎、喘息性疾病、急性喉炎甚至结核感染,对于病史不详、诱因不明、长期慢性咳嗽的患儿建议及时行纤维支气管镜检查或硬性支气管镜检查,减少呼吸道异物的漏诊、误诊。Objective To explore the correlative factors of missed diagnosis and misdiagnosis of foreign body of respiratory tract in children.Methods Retrospective analysis was performed for a total of 3492 children with foreign body of respiratory tract.They were divided into early and late diagnosis groups according to whether confirmation time was within 24 h or not.Then comparative analysis of relative factors was made with different regions,history of foreign body mistakenly choking,type and staying site of foreign body,frequency and conditions of seeking medical consultations.Results Among them,22.23%urban and 17.54%rural children could be diagnosed early.And there were regional variations in the percentages of an early diagnosis(χ2=10.583,P<0.05).Although 61.02%metal foreign bodies could be definitely diagnosed early,only 17.60%botanic foreign bodies were pinpointed early.Variations existed in the percentages of different foreign bodies diagnosed early versus late(χ2=104.025,P<0.05);40.82%throat foreign bodies were diagnosed early within 24h of choking.And the percentages of tracheal and bronchial foreign bodies diagnosed within 24h were 37.77%and 14.60%.Variations existed in the percentages of different sites of foreign bodies diagnosed early versus late(χ2=188.773,P<0.05).The percentage of one-time diagnosis was 89.12%in early diagnosis group and 31.13%in late diagnosis group.Those seeking 2-3 consultations accounted for 54.73%and over 3 consultations 14.13%.Variations existed in the percentages of different consultation sessions for foreign bodies diagnosed early versus late(χ2=741.310,P<0.05).All non-one-time confirmed cases were treated repeatedly as respiratory infections and asthmatic diseases prior to a definite diagnosis.Conclusion A delayed diagnosis of foreign body in respiratory tract is probably correlated with different regions,foreign body types,lodging sites and consultation frequency.It is easily misdiagnosed as pneumonia,asthmatic disease,acute sore throat and even tuberculous infection.For

关 键 词：儿童 呼吸道异物 延迟诊断 

分 类 号：R768.13[医药卫生—耳鼻咽喉科]