中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2011年
12期
947-951
,共5页
刘霞%倪彩云%王怀莲%张忠晓%马静%闫秀丽%张赟%肖俊%李娟%韩晓蓉%孟晨
劉霞%倪綵雲%王懷蓮%張忠曉%馬靜%閆秀麗%張赟%肖俊%李娟%韓曉蓉%孟晨
류하%예채운%왕부련%장충효%마정%염수려%장빈%초준%리연%한효용%맹신
误吸%支气管肺泡灌洗%儿童
誤吸%支氣管肺泡灌洗%兒童
오흡%지기관폐포관세%인동
Accidental aspiration%Bronchoalveolar lavage%Child
目的 探讨支气管镜下肺泡灌洗在儿童液体及粉末状异物吸入意外事故诊疗中的应用.方法 21例患儿,按误吸的种类分为:①油脂类3例；②化学溶剂类2例；③水溶性类15例；④粉状类1例.发生意外3d内住院的患儿有18例(其中有16例在1d内就诊),发生意外3d以后就诊的有3例.对入院患儿立即给予支气管镜下直接吸引清除和肺泡灌洗清除,以尽快清除吸入的异物,通畅气道,减少吸入物继续吸收和对气道黏膜的局部刺激,防止感染.依据患儿气管镜下所见、临床表现、实验室检查和胸部影像改变,评价疗效、决定是否再次气管镜下治疗和判断预后.结果 21例有不同程度呼吸困难,支气管镜下可见黏膜皆充血、水肿及分泌物附着.灌洗液多呈洗肉水样并明显混有大量吸入物.经2～5次治疗后,18例(86％)痊愈.3例(溺油井、吸入蚊香液、溺粪各1例)或因气道堵塞严重、灌洗困难,病情进行性加重,或因病后3d就诊而贻误病机,或合并真菌感染、气胸最终呼吸衰竭死亡.结论 在儿童液体和粉末状异物吸入意外事故处理中,尽早、多次采用支气管镜下肺泡灌洗是必要和安全有效的诊断治疗方法,吸入物种类、就诊时间、合并感染影响疗效.
目的 探討支氣管鏡下肺泡灌洗在兒童液體及粉末狀異物吸入意外事故診療中的應用.方法 21例患兒,按誤吸的種類分為:①油脂類3例；②化學溶劑類2例；③水溶性類15例；④粉狀類1例.髮生意外3d內住院的患兒有18例(其中有16例在1d內就診),髮生意外3d以後就診的有3例.對入院患兒立即給予支氣管鏡下直接吸引清除和肺泡灌洗清除,以儘快清除吸入的異物,通暢氣道,減少吸入物繼續吸收和對氣道黏膜的跼部刺激,防止感染.依據患兒氣管鏡下所見、臨床錶現、實驗室檢查和胸部影像改變,評價療效、決定是否再次氣管鏡下治療和判斷預後.結果 21例有不同程度呼吸睏難,支氣管鏡下可見黏膜皆充血、水腫及分泌物附著.灌洗液多呈洗肉水樣併明顯混有大量吸入物.經2～5次治療後,18例(86％)痊愈.3例(溺油井、吸入蚊香液、溺糞各1例)或因氣道堵塞嚴重、灌洗睏難,病情進行性加重,或因病後3d就診而貽誤病機,或閤併真菌感染、氣胸最終呼吸衰竭死亡.結論 在兒童液體和粉末狀異物吸入意外事故處理中,儘早、多次採用支氣管鏡下肺泡灌洗是必要和安全有效的診斷治療方法,吸入物種類、就診時間、閤併感染影響療效.
목적 탐토지기관경하폐포관세재인동액체급분말상이물흡입의외사고진료중적응용.방법 21례환인,안오흡적충류분위:①유지류3례；②화학용제류2례；③수용성류15례；④분상류1례.발생의외3d내주원적환인유18례(기중유16례재1d내취진),발생의외3d이후취진적유3례.대입원환인립즉급여지기관경하직접흡인청제화폐포관세청제,이진쾌청제흡입적이물,통창기도,감소흡입물계속흡수화대기도점막적국부자격,방지감염.의거환인기관경하소견、림상표현、실험실검사화흉부영상개변,평개료효、결정시부재차기관경하치료화판단예후.결과 21례유불동정도호흡곤난,지기관경하가견점막개충혈、수종급분비물부착.관세액다정세육수양병명현혼유대량흡입물.경2～5차치료후,18례(86％)전유.3례(닉유정、흡입문향액、닉분각1례)혹인기도도새엄중、관세곤난,병정진행성가중,혹인병후3d취진이이오병궤,혹합병진균감염、기흉최종호흡쇠갈사망.결론 재인동액체화분말상이물흡입의외사고처리중,진조、다차채용지기관경하폐포관세시필요화안전유효적진단치료방법,흡입물충류、취진시간、합병감염영향료효.
Objective To evaluate the effect of bronchoalveolar lavage (BAL) through bronchoscopy in diagnosis and treatment of accidental inhalation of liquid and powdery foreign bodies in children.Method Twenty-one cases of accidental inhalation were classified into the following 4 groups according to the materials inhaled:3 cases inhaled the lipidic material; 2 cases inhaled chemical material;15 cases inhaled hydrosoluble materials; 1 case inhaled powdery material.Eighteen cases were hospitalized within 3 days after the accidents,which included 16 cases treated within 1 day in hospital.And 3 cases were hospitalized 3 days after the accident.After hospitalization,all patients were immediately treated with direct aspiration and lavage clearance method through bronchoscopy.The inhaled foreign materials were cleared as soon as possible,which reduced the absorption,stimulation and infection of respiratory mucosa.The therapeutic effect was evaluated by endoscopic findings,clinical manifestation,laboratory examination and chest imaging.At the same time,decision was made on the second BAL and the prognosis was estimated.Result Twenty-one cases had dyspnea of certain degree.The bronchial mucous membrane of all the 21cases showed hyperemia,edema and exudate attached.Lavage fluid looked like broth and contained much of the inhaled material.After two to five times treatment,18 cases were cured ( 86％ ),but 3 cases died ( 14％ ).One of these 3 cases fell into an oil well,1 into mosquito repellent solution,another into manure pit.The patients who could not survive had severe airway obstruction,which was difficult to clean and made the problem deteriorated progressively.One of the patients was sent to a hospital 3 days after the accident and another case developed fungal infection,pneumothorax and finally respiratory failure.Conclusion BAL through bronchoscopy is necessary for children who accidentally inhaled liquid and powdery materials.This treatment is safe and effective in diagnosis and treatment of such problems in children.The effect of treatment is influenced by types of inhaled material,the time of lavagee clearance through bronchoscopy,and certain complications,such as infection etc.
