儿童气管-支气管异物十年临床经验总结  

Summary of clinical experience on tracheobronchial foreign bodies in children for 10 years

作　　者：王永军[1,2] 王文媛 摆翔 李晗怡 王忠弢[1] 王海珍 石永生[1] 易彬[2] Wang Yongjun;Wang Wenyuan;Bai Xiang;Li Hanyi;Wang Zhongtao;Wang Haizhen;Shi Yongsheng;Yi Bin(Pediatric Respiratory Department of Gansu Provincial Maternity and Child-care Hospital,Lanzhou 730050,China;Gansu Pediatric Clinical Medical Research Center of Gansu Provincial Maternity and Child-care Hospital,Lanzhou 730050,China;Anesthesia Surgery Department of Gansu Provincial Maternity and Child-care Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院小儿呼吸科,兰州730050 [2]甘肃省儿科临床医学研究中心,兰州730050 [3]甘肃省妇幼保健院麻醉手术室科,兰州730050

出　　处：《中国小儿急救医学》2021年第4期325-328,共4页Chinese Pediatric Emergency Medicine

基　　金：甘肃省卫生行业科研计划管理项目(GWGL2014-22)。

摘　　要：目的探讨儿童气管-支气管异物的临床表现及特征,提高异物的诊断及治疗疗效。方法选取2010年1月至2019年12月就诊于甘肃省妇幼保健院的气管-支气管异物患儿,对其临床资料进行回顾性分析总结。结果共967例患儿,均采用可曲式电子支气管镜进行手术,采用异物钳、活检钳或网篮套取的方式取出异物。其中未取出19例(3例声门下异物,1例别针,其余15例均为异物被肉芽完全包裹),住院后自行咳出2例,取出946例(97.8%),无死亡病例。儿童支气管异物好发于男孩,男女比例为2.14∶1,主要发病年龄为1~3岁856例(88.8%),农村稍多于城市(城市46.5%,农村53.5%)。气管-支气管异物发生最多的是3月份,最少的是6月份,冬春季节多于夏秋季节。吸入的异物种类以外源性的植物类异物为主,约占93.0%,其中花生(31.7%)和瓜子(19.2%)最常见。异物吸入的病程分布,1~3 d最多347例(35.9%)。内镜下合并支气管内膜炎的患儿501例(51.8%),有不同程度肉芽组织增生的患儿有196例,占支气管内膜炎患儿的39.1%,占总病例数的20.3%。支气管异物停留在右侧支气管占50.0%,左侧支气管占43.7%,右侧多于左侧。通过影像学确诊的有793例,阳性率达81.9%,而CT的确诊率达90.9%。结论约88.8%的气管-支气管异物发生在1~3岁。气管-支气管异物的发生具有明显的性别、城乡和季节分布特征,男性多于女性,农村高于城市,冬春季节多于夏秋季节。Objective To investigate the clinical manifestations and characteristics of tracheobronchial foreign bodies in children,and improve the diagnosis and treatment of foreign bodies.Methods A retrospective analysis was performed on the clinical data of children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between January 2010 to December 2019.The children with tracheobronchial foreign body who were treated in the Maternal and Child Health Hospital of Gansu Province.Results A total of 967 cases were operated by soft electronic bronchoscope,and foreign bodies were removed by means of foreign body forceps or nets.Among them,19 cases(3 cases with subglottic foreign bodies,one with row of pins,and the rest 15 cases with foreign bodies completely wrapped by granulation)were not removed,two cases were spontaneously coughed,and 946 cases(97.8%)were removed.Bronchial foreign bodies in children were more common in boys,with the ratio of male to female being 2.14∶1.The main age of onset was 1-3 years old(88.8%).The incidence was slightly higher in rural areas than that in urban areas(46.5%in urban areas,53.5%in rural areas).Foreign bodies were inhaled most in March and least in June.From the perspective of season,winter and spring were more than summer and autumn.The foreign body types inhaled were mainly exogenous plant foreign body,accounting for 93.0%,among which peanut(31.7%)and melon seeds(19.2%)were the most common.The duration of foreign body inhalation was up to 347 cases(35.9%)in 1-3 days.There were 501 cases(51.8%)with endoscopic endobronchial inflammation,and 196 cases of children with varying degrees of granulomatous hyperplasia,accounting for 39.1%and 20.3%of the total.The foreign body in the right bronchus accounted for 50.0%and the left bronchus for 43.7%.There were 793 cases confirmed by imaging,with a positive rate of 81.9%,and 90.9%confirmed by CT.Conclusion About 88.8%of tracheobronchial foreign bodies occurred in 1 to 3 years of age.The occurrence of foreign bodies had obvious

关 键 词：气管-支气管异物 儿童 呼吸困难 电子支气管镜 

分 类 号：R768.13[医药卫生—耳鼻咽喉科]