中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
18期
1383-1386
,共4页
许煊%祝彬%石苗茜%任海丽%封志纯
許煊%祝彬%石苗茜%任海麗%封誌純
허훤%축빈%석묘천%임해려%봉지순
软式支气管镜%气管支气管异物%氩等离子体凝固%冷冻技术%肉芽组织%儿童
軟式支氣管鏡%氣管支氣管異物%氬等離子體凝固%冷凍技術%肉芽組織%兒童
연식지기관경%기관지기관이물%아등리자체응고%냉동기술%육아조직%인동
Flexible bronchoscopy%Tracheobronchial foreign body%Argon plasma coagulation%Freezing tech-niques%Granulation tissue%Child
目的：提出儿童异物吸入的预防建议,探讨软式支气管镜( FB)在儿童气管支气管异物诊断及治疗中的有效性、安全性及应用经验。方法回顾性总结2013年1月至2014年12月北京军区总医院附属八一儿童医院对38例呼吸道异物在FB下取出,并对出现肉芽组织增生的患儿进行氩气刀( APC)联合二氧化碳( CO2)冷冻治疗经验,分析患儿临床资料,包括年龄、性别、吸入异物至就诊的时间、临床及X线表现、异物所在位置、支气管镜与 APC 及冷冻治疗、并发症和结局情况。结果38例患儿中男31例(81.6%),女7例(18.4%)；年龄10个月~14岁,平均年龄28.5个月；有明确异物史30例(78.9%)。最常见临床症状为呛咳(84.3%)；X 线胸片示15例表现为患侧肺不张(39.5%),肺气肿17例(44.7%),肺炎改变6例(15.8%),11例来院时行肺部CT检查,仅1例见有异物影；镜检发现吸入的异物位于右侧支气管22例(57.9%),花生米是本组患儿吸入的主要异物；仅4例(10.5%)在异物吸入24 h内诊明确诊断并取出异物,34例(89.5%)于异物吸入24 h 后才明确诊断及治疗；儿童哭闹是导致异物吸入的首要诱因。38例患儿吸入异物全部在FB下取出。有19例(50.0%)在异物周围有肉芽组织增生,其中5例异物被增生的肉芽组织包裹,用APC处理异物表面的肉芽组织暴露异物后取出,然后予CO2冷冻治疗；9例异物周围有肉芽组织但未形成包裹,取出异物后直接予CO2冷冻治疗。本组1例术中有心动过缓,2例术后少量出血,无相关性死亡病例。结论对3岁以下的婴幼儿父母进行饮食习惯及喂养方法的教育是预防婴幼儿异物吸入的关键,FB下可安全取出呼吸道异物且并发症少,是异物吸入呼吸道诊断及治疗的可选方法之一。
目的：提齣兒童異物吸入的預防建議,探討軟式支氣管鏡( FB)在兒童氣管支氣管異物診斷及治療中的有效性、安全性及應用經驗。方法迴顧性總結2013年1月至2014年12月北京軍區總醫院附屬八一兒童醫院對38例呼吸道異物在FB下取齣,併對齣現肉芽組織增生的患兒進行氬氣刀( APC)聯閤二氧化碳( CO2)冷凍治療經驗,分析患兒臨床資料,包括年齡、性彆、吸入異物至就診的時間、臨床及X線錶現、異物所在位置、支氣管鏡與 APC 及冷凍治療、併髮癥和結跼情況。結果38例患兒中男31例(81.6%),女7例(18.4%)；年齡10箇月~14歲,平均年齡28.5箇月；有明確異物史30例(78.9%)。最常見臨床癥狀為嗆咳(84.3%)；X 線胸片示15例錶現為患側肺不張(39.5%),肺氣腫17例(44.7%),肺炎改變6例(15.8%),11例來院時行肺部CT檢查,僅1例見有異物影；鏡檢髮現吸入的異物位于右側支氣管22例(57.9%),花生米是本組患兒吸入的主要異物；僅4例(10.5%)在異物吸入24 h內診明確診斷併取齣異物,34例(89.5%)于異物吸入24 h 後纔明確診斷及治療；兒童哭鬧是導緻異物吸入的首要誘因。38例患兒吸入異物全部在FB下取齣。有19例(50.0%)在異物週圍有肉芽組織增生,其中5例異物被增生的肉芽組織包裹,用APC處理異物錶麵的肉芽組織暴露異物後取齣,然後予CO2冷凍治療；9例異物週圍有肉芽組織但未形成包裹,取齣異物後直接予CO2冷凍治療。本組1例術中有心動過緩,2例術後少量齣血,無相關性死亡病例。結論對3歲以下的嬰幼兒父母進行飲食習慣及餵養方法的教育是預防嬰幼兒異物吸入的關鍵,FB下可安全取齣呼吸道異物且併髮癥少,是異物吸入呼吸道診斷及治療的可選方法之一。
목적：제출인동이물흡입적예방건의,탐토연식지기관경( FB)재인동기관지기관이물진단급치료중적유효성、안전성급응용경험。방법회고성총결2013년1월지2014년12월북경군구총의원부속팔일인동의원대38례호흡도이물재FB하취출,병대출현육아조직증생적환인진행아기도( APC)연합이양화탄( CO2)냉동치료경험,분석환인림상자료,포괄년령、성별、흡입이물지취진적시간、림상급X선표현、이물소재위치、지기관경여 APC 급냉동치료、병발증화결국정황。결과38례환인중남31례(81.6%),녀7례(18.4%)；년령10개월~14세,평균년령28.5개월；유명학이물사30례(78.9%)。최상견림상증상위창해(84.3%)；X 선흉편시15례표현위환측폐불장(39.5%),폐기종17례(44.7%),폐염개변6례(15.8%),11례래원시행폐부CT검사,부1례견유이물영；경검발현흡입적이물위우우측지기관22례(57.9%),화생미시본조환인흡입적주요이물；부4례(10.5%)재이물흡입24 h내진명학진단병취출이물,34례(89.5%)우이물흡입24 h 후재명학진단급치료；인동곡료시도치이물흡입적수요유인。38례환인흡입이물전부재FB하취출。유19례(50.0%)재이물주위유육아조직증생,기중5례이물피증생적육아조직포과,용APC처리이물표면적육아조직폭로이물후취출,연후여CO2냉동치료；9례이물주위유육아조직단미형성포과,취출이물후직접여CO2냉동치료。본조1례술중유심동과완,2례술후소량출혈,무상관성사망병례。결론대3세이하적영유인부모진행음식습관급위양방법적교육시예방영유인이물흡입적관건,FB하가안전취출호흡도이물차병발증소,시이물흡입호흡도진단급치료적가선방법지일。
Objective To put forward the prevention advice on foreign body suction,and to discuss the effica-cy,safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bron-choscopy and granulation tissue proliferation in Argon plasma coagulation ( APC ) ( argon knife ) combining carbon dioxide( CO2 ) cryotherapy in Bayi Children′s Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed,and the clinical data including age,gender,treatment time for inhaled foreign body,clinical and X-ray manifestations,location of the foreign body,treatment with bronchoscopy with APC and cryotherapy,complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male (81. 6%) and 7 female(18. 4%),aged from 10 months to 14 years old,with mean age 28. 5 months;among them there were 30 cases with definite history of foreign body,accounting for 78. 9%;the most common clinical symptom was cough among the cases,accounting for 84. 3%;X ray showed 15 cases with ipsilateral lung atelectasis,accounting for 39. 5%, emphysema in 17 cases,accounting for 44. 7%,pneumonia change in 6 cases,accounting for 15. 8%,there were 11 ca-ses who had lung computerized tomography examination when coming to the hospital,and only 1 case could be seen to have foreign body shadow;microscopic examination found that inhaled foreign body in the right bronchus accounted for 57. 9%,and peanut was the main foreign body inhalation in this group;only 4 cases(10. 5%) had definite diagnosis and foreign body removal within 24 h after foreign body aspiration,moreover,34 cases(89. 5%) with foreign body aspi-ration got the diagnosis and treatment after 24 h;crying was the primary inducement for inhaled foreign body. All the 38 cases of children with inhaled foreign body experienced removal under flexible bronchoscopy. There were 19 cases (50. 0%) who had granulation tissue proliferation around the foreign body,among which 5 cases of foreign body was wrapped by the proliferation of granulation tissue,with APC dealing with the granulation tissue of foreign body surface to remove foreign body after exposure,then giving CO2 cryotherapy. Nevertheless,there were 9 cases of foreign body who had granulation tissue but was not wrapped,receiving CO2 cryotherapy directly after the foreign body removal. One case of this group had bradycardia during the surgery,and 2 cases had postoperative bleeding,but there was no death cases with foreign bodies removal. Conclusions Education is the key to prevent foreign body aspiration in infants under 3 years old. Flexible bronchoscopy is safe to remove foreign bodies from the respiratory tract and has fewer complications, so it is one of the alternative methods in diagnosis and treatment of foreign body inhalation.
