Huang Min,Zhao Sijun,Wu Xionghui,et al.Analysis of correlative factors of delayed diagnosis of respiratory foreign body in children.[J].Journal of Clinical Pediatric Surgery,2018,17(10):778-782.
儿童呼吸道异物延迟诊断的相关因素分析
- Title:
- Analysis of correlative factors of delayed diagnosis of respiratory foreign body in children.
- Keywords:
- Children; Respiratory foreign body; Delayed diagnosis
- 文献标志码:
- A
- 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(χ2=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（χ2=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(χ2=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（χ2=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。
- Abstract:
- ObjectiveTo explore the correlative factors of missed diagnosis and misdiagnosis of foreign body of respiratory tract in children.MethodsRetrospective 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.ResultsAmong 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 onetime 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 nononetime confirmed cases were treated repeatedly as respiratory infections and asthmatic diseases prior to a definite diagnosis.ConclusionA 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 those with a nonspecific history,nondefinite precipitating factors and chronic cough,fiberoptic or rigid bronchoscope is recommended for minimizing the underdiagnosis or misdiagnosis of foreign body in respiratory tract.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(10):413.
[2]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[3]王勇,汤绍涛,毛永忠,等.腔镜下手术治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(06):441.
[4]欧阳帆,张治明,曾宾,等.七氟醚复合髂腹股沟-髂腹下神经阻滞用于小儿腹股沟手术[J].临床小儿外科杂志,2010,9(06):466.
[5]徐华,赵陶丽.瑞芬太尼对小儿等离子刀扁桃体腺样体切除术应激反应的影响[J].临床小儿外科杂志,2010,9(06):468.
[6]周辉霞孙宁马立飞孟浩谢华伟申州陶天周晓光黄澄如李宏召张旭.腹腔镜下重复肾半肾切除术手术路径探讨[J].临床小儿外科杂志,2011,10(01):0.
ZHOU Hui xia,SU Ning,MA Li fei,et al.Which laparoscopic surgery approach is better for a nonfunctioning moiety in a duplex kidney in infants and children[J].Journal of Clinical Pediatric Surgery,2011,10(10):0.
[7]蒋欣李箭刘利君彭明惺唐学阳.儿童单纯性膝关节骨软骨骨折的关节镜治疗[J].临床小儿外科杂志,2011,10(01):0.
JIANG Xin,LI Jian,LIU Li jun,et al.Arthroscopic therapy of osteochondral fractures of the Knee in children.[J].Journal of Clinical Pediatric Surgery,2011,10(10):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(10):0.
[9]寿铁军李勇马能强龚晟.腹腔镜手术治疗小儿腹股沟斜疝1582例[J].临床小儿外科杂志,2011,10(01):0.
[10]吴臻斐陈聪德林进汉刘平李仲荣陈肖鸣.小儿急性肠套叠肠坏死相关因素分析[J].临床小儿外科杂志,2011,10(01):0.
[11]刘婷婷 张钦明 周红 焦丽丽 陈永卫. 肠内营养在儿童胰腺外伤治疗中的应用[J].临床小儿外科杂志,2011,10(02):84.
LIU Ting ting,ZHANG Qin ming,ZHOU Hong,et al. Enteral nutrition treatment in the application of pancreas trauma of children.[J].Journal of Clinical Pediatric Surgery,2011,10(10):84.
[12]吕成超 黄河. 儿童慢性阑尾炎腹腔镜治疗28例临床分析[J].临床小儿外科杂志,2011,10(02):121.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):121.
[13]杨维. 儿童甲状旁腺腺瘤8例诊治分析[J].临床小儿外科杂志,2011,10(02):123.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):123.
[14]刘金桥 何静波 陈文娟 陈叶 杨芳 尹海燕.高频超声及彩色多普勒对小儿睾丸肿瘤的诊断价值[J].临床小儿外科杂志,2011,10(02):130.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):130.
[15]陈志勇 游洁玉 欧阳文献 赵红梅 周小渔 段白萍. 238例便血患儿结肠镜检查分析[J].临床小儿外科杂志,2011,10(02):135.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):135.
[16]程富礼 孙琳 于凤章 景小博 张庆玉. 应用改良皮下棒技术治疗小儿脊柱侧凸13例[J].临床小儿外科杂志,2011,10(02):151.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):151.
[17]顾胜利 罗雪松. 阴茎腹侧皮瓣切除术治疗小儿隐匿阴茎[J].临床小儿外科杂志,2011,10(02):153.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):153.
[18]魏晓明 李索林 王昆 刘树立 李龙 李英超. 腹腔镜诊治小儿肠系膜囊肿的疗效评价[J].临床小儿外科杂志,2011,10(02):154.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):154.
[19]沈太伟 吕良英 李心元 王伟. 小儿肝外伤后胆汁性肝囊肿及胆汁性肺瘘3例[J].临床小儿外科杂志,2011,10(02):156.
[J].Journal of Clinical Pediatric Surgery,2011,10(10):156.
[20]梅海波. 包裹式自体髂骨移植治疗儿童先天性胫骨假关节的疗效观察[J].临床小儿外科杂志,2011,10(03):163.