清远地区0~14岁儿童外源性气管支气管异物流行特点分析及预防对策探讨  

Epidemiological Features and Prevention Strategies of Exogenous Tracheobronchial Foreign Bodies in Children from Qingyuan

作　　者：黄庆[1] 潘家龙 陈翠芳[2] 雷俊杰[3] 林冬云[1] HUANG Qing;PAN Jia-long;CHEN Cui-fang;LEI Jun-jie;LIN Dong-yun(Department of Pediatrics,The Affiliated Qingyuan Hospital(Qingyuan People's Hospital),Guangzhou Medical University,Qingyuan 511500,China;Department of Otolaryngology,The Affiliated Qingyuan Hospital(Qingyuan People's Hospital),Guangzhou Medical University,Qingyuan 511500,China;Department of Radiology,The Affiliated Qingyuan Hospital(Qingyuan People's Hospital),Guangzhou Medical University,Qingyuan 511500,China)

机构地区：[1]广州医科大学附属清远医院(清远市人民医院)儿科,清远511500 [2]广州医科大学附属清远医院(清远市人民医院)耳鼻喉科,清远511500 [3]广州医科大学附属清远医院(清远市人民医院)放射科,清远511500

出　　处：《伤害医学（电子版）》2024年第2期13-21,共9页Injury Medicine（Electronic Edition）

摘　　要：目的分析清远地区儿童外源性气管支气管异物(tracheobronchial foreign bodies,TFBs)的流行特点,并探讨预防对策。方法回顾2013年至2022年间清远市人民医院收治的14岁以下儿童外源性TFBs病例,收集并分析患儿的性别、发病年龄、居住地、发病时间、诱发因素、异物种类、异物滞留时间、异物滞留部位、并发症、治疗、转归等,总结其流行特点,并据此探讨预防对策。结果共纳入159例,其中101例(63.52%)来自农村,58例(36.48%)来自城市。发病高峰出现在冬季(66例,41.51%)。发病年龄在4~95月龄,多数(139例,87.42%)在36月龄以下。男性99例(62.26%),女性60例(37.74%),男女比例1.65:1。异物种类以坚果和种子类(128例,80.50%)及动物骨骼(15例,9.43%)为主。坚果和种子类异物中最常见的是花生(64例,40.25%)和瓜子(46例,28.93%),之后为黄皮果核(6例,3.77%)。坚果和种子类异物在12月龄患儿中更常见(χ^(2)=25.895,P<0.001),而动物骨骼类异物在0~11月龄患儿中更常见(χ^(2)=38.590,P<0.001)。多数患儿(142例,89.31%)在进食过程中发病,其中,进食坚果和种子类诱发者在≥12月龄患儿中更常见(χ^(2)=22.365,P<0.001),而进食带骨食物诱发者在0~11月龄患儿中更常见(P<0.001)。0~11月龄患儿进食带骨食物诱发者共8例,其中进食猪骨粥诱发者7例,进食黄鳝粥诱发者1例。大多数患儿(148例,93.08%)发病时有监护人在场。气管异物在≥24月龄患儿中更常见(χ^(2)-7.367,P=0.007),而单侧支气管异物则在0~23月龄患儿中更常见(χ^(2)=5.210,P=0.022)。多因素Logistic回归分析结果提示较长的异物滞留时间(OR=1.489,95%CI:1.098,2.020)和较小的发病年龄(OR=0.646,95%CI:0.459,0.908)是发生并发症的两个独立危险因素。159例患儿经治疗后痊愈出院151例(94.97%),转诊7例(4.40%),死亡1例(0.63%)。结论与年龄不匹配的食物暴露是清远地区儿童发生外源性TFBs的主要诱因,花生、瓜子、带骨食物及Objective To identify epidemiological features of exogenous tracheobronchial foreign bodies(TFBs)in children in Qingyuan and to recommend its prevention strategies.Methods A review was conducted on cases of exogenous TFBs in children under 14 years old who were admitted to the Qingyuan People's Hospital from 2013 to 2022.From these patients,the gender,age of onset,place of residence,onset time,triggering factors,types of foreign bodies,duration of foreign body retention,location of foreign body retention,comorbidities,treatment,outcomes,etc.were collected and analyzed.Based on these data,prevention strategies were investigated.Results Among the 159 cases identified,101(63.52%)came from rural areas and 58 cases(36.48%)from urban areas.There were 99 males(62.26%)and 60 females(37.74%),with a male to female ratio of 1.65:1.The peak incidence occurred during the winter(66 cases,41.51%).The age of onset ranged from 4 to 95 months,with the majority(139 cases,87.42%)being under 36 months.The main types of foreign bodies were nuts and seeds(128 cases,80.50%)and animal bones(15 cases,9.43%).The most common types of nuts and seeds were peanuts(64 cases,40.25%),sunflower seeds(46 cases,28.93%),followed by Clausena lansium seeds(6 cases,3.77%).Nuts and seeds were more common among cases with age≥12 months(χ^(2)=25.895,P<0.001),while animal bones were more common in cases with age 0-11 months(χ^(2)=38.590,P<0.001).When exogenous TFBs occurred,most cases(142 cases,89.31%)were from eating.Cases induced by eating nuts and seeds were more common in children aged≥12 months(χ^(2)=22.365,P<0.001),while cases induced by eating bony foods were more common in children aged 0-11 months(P<0.001).Among the latter,7 cases ate pig bone congee and 1 case ate rice eel congee.When exogenous TFBs occurred,most of the patients(148 cases,93.08%)had a guardian present.Tracheal foreign bodies were more common in children aged≥24 months(χ^(2)=7.367,P=0.007),while unilateral bronchial foreign bodies were more common in those aged 0-23 month

关 键 词：气管异物 气管支气管异物 流行病学 预防 儿童 

分 类 号：R768.13[医药卫生—耳鼻咽喉科]