儿童气管支气管异物并发心跳骤停的急救处理及预后分析  

Emergency treatment and prognosis analysis of cardiac arrest in children with tracheobronchial foreign bodies

作　　者：僧东杰 益欢欢 李颖[1] 王晓东[1] 乾恩乐[1] 韩富根 SENG Dong-jie;YI Huan-huan;LI Ying;WANG Xiao-dong;QIAN En-le;HAN Fu-gen(Department of Otorhinolaryngology,Zhengzhou Childrens Hospital Affiliated to Zhengzhou University,Zhengzhou,450053,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院耳鼻咽喉科,郑州450000

出　　处：《医药论坛杂志》2020年第8期26-29,共4页Journal of Medical Forum

摘　　要：目的探讨气管支气管异物导致小儿心跳骤停的相关因素、急救措施和预后。方法回顾性分析郑州儿童医院耳鼻咽喉科2016年1月至2019年1月收治的4052例气管支气管异物患儿的临床资料,其中有18例患儿出现术前或术中心跳骤停。患儿年龄最小10月,最大4岁11月,中位年龄1岁7月,男11例,女7例,病史最短30 min,最长12天。一旦发现患儿围手术期心跳骤停,立即实施心肺复苏。复苏成功后转入SICU呼吸机辅助呼吸或立即全麻行内镜下气管支气管异物取出术。结果本组18例患儿中14例院前未出现心跳骤停,在麻醉诱导和手术过程中突发心跳骤停,经过积极有效的抢救,抢救成功,术后无严重并发症。院前出现心跳骤停的4例患儿,2例由于心跳停止时间较长(家长诉约10 min),心肺复苏无果,死亡。1例心肺复苏成功后转入SICU,病情相对稳定后实施全麻内镜下气管支气管异物取出术,手术过程顺利,术后痊愈出院。1例由于呼吸心跳停止时间较长,虽然心肺复苏成功并顺利实施手术,但术后出现了严重的中枢神经系统并发症,并行长期的康复治疗。结论小儿呼吸道异物病情急危,总气道或双侧支气管异物更易堵塞气道,导致患儿缺氧而突发心跳骤停,及时有效的心肺复苏和快捷精准的异物取出术是提高治愈率、降低死亡率、减少术后并发症的主要方法。Objective To investigate the emergency measures and prognosis of cardiac arrest in children caused by tracheobronchial foreign bod.Methods The clinical data of 4052 cases of children with tracheobronchial foreign body admitted to the otolaryngology department of zhengzhou children’s hospital from January 2016 to January 2019 were retrospectively analyzed,among which 18 cases had preoperative or surgical center arrest.The patients were as young as 10 months,as old as 4 years and in November,with a median age of 1 year and 7 months,including 11 males and 7 females.The medical history was as short as 30 minutes and as long as 12 days.Cardiopulmonary resuscitation should be performed as soon as perioperative cardiac arrest is found.After successful resuscitation,the patient was transferred to SICU ventilator assisted breathing or underwent endoscopic removal of tracheobronchial foreign body under immediate general anesthesia.Results Among the 18 children in this group,14 did not have cardiac arrest before hospital,but had sudden cardiac arrest during anesthesia induction and operation.After active and effective rescue,the rescue was successful and there were no serious postoperative complications.Among the 4 children with cardiac arrest before hospital,2 died due to the long time of cardiac arrest(parents complained about 10 minutes).After successful cardiopulmonary resuscitation,one patient was transferred to SICU,and after the condition was relatively stable,the patient underwent endoscopic removal of tracheobronchial foreign body under general anesthesia.The operation went smoothly,and he was cured and discharged from hospital after surgery.Due to the long time of respiratory and cardiac arrest in one case,although cardiopulmonary resuscitation was successful and the operation was carried out smoothly,serious central nervous system complications occurred after the operation,and long-term rehabilitation was also conducted.Conclusion Foreign bodies in respiratory tract in children are very dangerous,and the total

关 键 词：儿童 支气管异物 心跳骤停 心肺复苏 预后 

分 类 号：R768.13[医药卫生—耳鼻咽喉科]