儿童呼吸道异物早晚期诊断与异物类型、部位及并发症的关系研究
黄 敏1,彭湘粤1,赵斯君1,陶礼华1,吴欢欢2

1,湖南省儿童医院耳鼻咽喉头颈外科(湖南省长沙市,410007); 2,湖南省第二人民医院(湖南省长沙市,410005)

儿童呼吸道异物; 异物类型; 并发症; 早期诊断

Relationship between types of foreign body and early diagnosis and complications of foreign body aspiration in children.
Huang Min1, Peng Xiangyue1, Zhao Sijun1, Tao Lihua1, Wu Huanghuang2.

1.Department of Otorhinolaryngology-Head & Neck Surgery, Hunan Children's Hospital, Changsha 410007, China; 2.Department of Otorhinolaryngology-Head & Neck Surgery, Second Hunan Provincial People's Hospital, Changsha 410005, China,Corresponding au

Foreign Body Aspiration in Children; Type of Foreign Body; Complications; Early Diagnosis

DOI: 10.3969/j.issn.1671-6353.2017.02.016

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目的 探讨儿童呼吸道异物早晚期诊断与异物类型、部位及术前并发症的关系。方法 回顾性分析本院收治的2 773例儿童呼吸道异物病例资料,按24 h内确诊和24 h之后确诊分为早期诊断组和晚期诊断组,比较异物类型、部位、并发症类型在两组间的统计学差异。 结果 本研究共2 773例呼吸道异物患儿,男女比例为1.89:1,异物类型以植物类异物2 561(92.35%)例为主,异物部位以支气管异物2 257(81.39%)为主,术前最常见的并发症为肺炎(43.30%)和肺气肿术(27.60%)。研究发现金属类异物早期诊断率明显高于植物性异物,不同异物类型早期诊断率存在差异( χ2=47.125,P<0.05))。早晚期诊断组患儿中术前肺炎、肺气肿的发生率存在差异,经统计学分析差异有统计学意义(P<0.001)。19例并发气胸者异物均为坚果类。除1例内源性异物患儿术后死亡外,其余病例均获治愈。术后新发并发症如肺水肿、气胸9例,二次手术4例,以上患儿异物均为坚果。17例气管、双侧支气管异物患儿因ARD转入ICU治疗,其中15例异物为坚果。 结论 异物类型是影响呼吸道异物能否早期确诊的相关因素,大多数坚果类异物由于发生场景无特殊、异物性状及滞留位置,早期难以确诊,病程越长,并发症发生率越高。对于气管、双侧支气管异物合并肺炎、气胸的患儿,坚果类异物也增加了发生ARD的风险性。
Objective To determine the relationship of foreign body(FB)types in early diagnosis, complications and prognosis of children with suspected FB aspiration. Methods The medical records of 2,773 children with an early and late diagnosis(within 24 h and after 24 h)were analyzed retrospectively. Types of FB and complications were compared between two groups. Results The proportion of metal FB was much higher than that of botanic FB( χ2=47.125,P<0.05). The most common complications included pneumonia(43.43%), emphysema(27.62%), pulmonary atelectasis(3.37%), pulmonary consolidation(0.63%)and pneumothorax(0.67%). The inter-group rate of pneumonia and emphysema had difference of statistical significance(P<0.001). Among them, FBs of 19 pneumothorax patients belonged to nuts. Only 1 patient died postoperatively due to endogenous foreign body. Nine patients had such postoperative complications as pneumonedema and pneumothorax. Four reoperated patients had nuts. Seventeen patients of FBs in tracheal and bilateral bronchus were transferred into intensive care unit due to acute respiratory dysfunction(ARD)and the type of FB was nuts. Conclusion s Location of FB is a critical factor of early diagnosis of foreign body aspiration in children. Most cases of FB aspiration are difficult to diagnose due to common scene, types of FB and location of FB. The longer courses of disease, more complications. Patients of FBs in tracheal and bilateral bronchus complicated with pneumonia and pneumothorax have an elevated risk of ARD.