CAJ | 학술논문

目的探讨儿童隐匿性支气管异物的临床特点,分析误诊原因及诊断思路.方法回顾分析重庆医科大学附属儿童医院2009年3月1日至2014年2月28日支气管异物1 710例中经支气管镜术确诊的隐匿性支气管异物22例的诊治经过.结果 22例中男15例,女7例;年龄9月8 d至14岁6个月;病程6d至1年.22例均无明确或可疑异物吸入史;无刺激性呛咳表现;体检未见气管偏移,未闻及气管拍击音;影像学检查未见直接支气管异物征象.行支气管镜术前诊断肺炎21例,肺结核1例;术前抗感染治疗病情反复7例,无效8例,使用特殊抗生素2例(万古霉素1例,注射用亚胺培南西司他丁钠1例),抗痨治疗1例.异物并发感染22例次,肺不张15例次,肺实变10例次,肺气肿4例次,胸腔积液5例次,支气管扩张4例次,呼吸衰竭1例次,败血症1例次.经支气管镜诊治后患儿临床症状基本缓解,肺部影像学征象痊愈3例,好转19例.结论儿童隐匿性支气管异物临床表现复杂,诊断困难,并发症多,危害大,对于婴幼儿反复肺部感染、有呼吸道阻塞间接征象、治疗困难的病例应高度警惕支气管异物可能,早期行支气管镜术有助于提高诊断正确率.
목적 탐토인동은닉성지기관이물적림상특점,분석오진원인급진단사로.방법 회고분석중경의과대학부속인동의원2009년3월1일지2014년2월28일지기관이물1 710례중경지기관경술학진적은닉성지기관이물22례적진치경과.결과 22례중남15례,녀7례;년령9월8 d지14세6개월;병정6d지1년.22례균무명학혹가의이물흡입사;무자격성창해표현;체검미견기관편이,미문급기관박격음;영상학검사미견직접지기관이물정상.행지기관경술전진단폐염21례,폐결핵1례;술전항감염치료병정반복7례,무효8례,사용특수항생소2례(만고매소1례,주사용아알배남서사타정납1례),항로치료1례.이물병발감염22례차,폐불장15례차,폐실변10례차,폐기종4례차,흉강적액5례차,지기관확장4례차,호흡쇠갈1례차,패혈증1례차.경지기관경진치후환인림상증상기본완해,폐부영상학정상전유3례,호전19례.결론 인동은닉성지기관이물림상표현복잡,진단곤난,병발증다,위해대,대우영유인반복폐부감염、유호흡도조새간접정상、치료곤난적병례응고도경척지기관이물가능,조기행지기관경술유조우제고진단정학솔.
Objective To investigate the clinical manifestation of children with occult bronchial foreign body,to analyze the reasons of misdiagnosis,to summarize the way of diagnosis and to emphasize the value of bronchoscopy in diagnosis and treatment of children with such disease.Method A retrospective analysis of 22 cases of occult bronchial foreign body diagnosed and treated with bronchoscopy in Children's Hospital of Chongqing Medical University during the period from March 1,2009 to February 28,2014.Result Of the 22 cases,15 were male and 7 female.Their age ranged from nine months and eight days to fourteen years and six months.The course of disease ranged in length from six days to one year.It took us one to thirty-three days in diagnosing the problem.They or their parents all denied aspirating foreign body and the patients did not have irritating chokes.They did not have tracheal displacement or flapping sound.There were no direct signs of bronchial foreign body in their imaging examination.Twenty-one patients were diagnosed as pneumonia before bronchoscopy,and the remaining one was diagnosed as tuberculosis.All of the patients were complicated with infection; atelectasis was found in 15 cases/times,lung consolidation in 10 cases/times,emphysema in 4,pleural effusion in 5,bronchiectasis in 4,one case had respiratory failure,one case had septicemia.The clinical symptoms were relieved in the patients after bronchoscopy,3 cases were cured,19 cases were improved.Conclusion Occult bronchial foreign body with certain complications and great harm is hard to diagnose.We should pay more attention to the important clues,such as a child with repeated pulmonary infection,indirect signs of airway obstruction and difficult to treat.Early bronchoscopy will be useful to improve diagnostics once the vital clue is found.