儿童气管支气管内异物延迟诊断临床相关因素分析  

Analysis of clinical factors related to delayed diagnosis of tracheobronchial foreign bodies in children

作　　者：郑宇 戴红臣[1] 李桂涛 毛国顺[1] 陈夏莹 朱影[1] ZHENG Yu;DAI Hong-chen;LI Gui-tao;MAO Guo-shun;CHEN Xia-ying;ZHU ying(Department of Pediatrics,Fuyang People′s Hospital,Fuyang,Anhui 236015,China)

机构地区：[1]阜阳市人民医院儿科,安徽阜阳236015

出　　处：《临床肺科杂志》2022年第11期1692-1695,1701,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探究儿童气管支气管内异物延迟诊断的原因,并进行临床分析。方法收集2020年1月至2021年6月就诊于阜阳市人民医院,且行电子支气管镜证实为气管支气管异物的患儿89例,根据确诊时间是否≤24h分为早期诊断组(n=46)与延迟诊断组(n=43),回顾性分析两组患儿临床资料的差异,并进行多因素Logistic回归分析,总结延迟诊断的原因及危险因素。结果延迟诊断与居住农村、未提供确切异物吸入史、首诊时未完善影像学检查、首诊于县级或以下的基层医院以及因误诊为肺炎、喘息性支气管炎等而反复就诊(次数≥2次)有关,且与支气管镜下表现异物为植物性、异物位置在分支气管因素有关,两组比较有统计学意义(P<0.05);多因素Logistic回归分析,显示就诊次数≥2次和异物在分支气管,是延迟诊断的高危因素,首诊三甲医院是延迟诊断的阻碍因素(P<0.05)。结论<3岁的农村居住幼儿出现无明显原因的反复咳嗽、喘息且治疗效果欠佳时,宜尽早去三甲医院完善气管CT三维重建检查,并及时行支气管镜检查取出异物,避免延迟诊治。Objective To explore the reasons of delayed diagnosis of tracheobronchial foreign bodies in children and conduct clinical analysis.Methods A total of 89 children who were admitted to Fuyang People′s Hospital from January 2020 to June 2021 and were confirmed to be tracheobronchial foreign bodies by electronic bronchoscopy were collected.They were divided into the early diagnosis group(n=46)and delayed diagnosis group(n=43)according to whether the foreign body was diagnosed within 24 hours.The differences in clinical data between the two groups were retrospectively analyzed,and logistic regression was performed to summarizethe reasons and risk factors for delayed diagnosis.Results In the delayed diagnosis group,these relative factors included the following:living in rural areas,failing to provide an exact history of foreign body inhalation,incomplete imaging examination at the first diagnosis,first diagnosis in a grass-roots hospital at or below the county level,and repeated visits(≥2times)due to misdiagnosis of pneumonia and asthmatic bronchitis.In addition,it was also closely related to the vegetative foreign body and location in the branching trachea.The comparison between the two groups was statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that the number of visits≥2 times and retention of foreign bodies in branch trachea was the high-risk factor for delayed diagnosis,and the first visit to a tertiary hospital was the hindering factor for delayed diagnosis(P<0.05).Conclusion When children aged<3 years living in rural areas have repeated coughing and wheezing for no apparent reason and the treatment effect is poor,it is advisable to go to a tertiary hospital as soon as possible to complete the tracheal CT three-dimensional reconstruction examination,and perform bronchoscopy to remove foreign bodies in time to avoid delaying diagnosis and treatment.

关 键 词：儿童 气管支气管异物 延迟诊断 临床分析 

分 类 号：R768.13[医药卫生—耳鼻咽喉科]