中国实用儿科杂志

中国实用儿科杂志

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儿童气管支气管异物临床特征分析（附228例报告）

  

  1. 厦门大学附属第一医院儿科， 福建  厦门  361000
  • 发布日期:2019-10-13

Clinical characteristics of tracheobronchial foreign body in children：A report of 228 cases

  1. Department of Pediatrics， the First Affiliated Hospital of Xiamen University， Xiamen  361000， China
  • Published:2019-10-13

摘要：

目的　探讨儿童气管支气管异物的临床特点、 诊治并分析气管内膜肉芽形成相关危险因素。 方法　回顾性分析2011年1月至2017年12月厦门大学附属第一医院儿科呼吸病房收治的228例确诊为气管支气管异物患儿的临床资料，并采用Logistic二元回归方法对气管支气管异物继发气道内膜肉芽形成的相关危险因素进行分析。结果　儿童气管支气管异物的高发年龄为1～3岁（76.3%），男女比例为2.3∶1。其中植物性异物居多（82.9%），异物好发部位左肺（52.6%）高于右肺（39.5%）。气管内膜肉芽形成（74.4%）、 肺炎（76.3%）、 肺气肿（51.3%）是气管支气管异物最常见的并发症。异物种类及异物残留时间是导致气管内膜肉芽形成的独立危险因素（P＜0.01），病程越长，肉芽形成的风险越大（P＜0.01）。经受试者工作特征（ROC）曲线下面积计算得出，异物残留时间可作为判断是否合并气管内膜肉芽形成的可靠预测指标，诊断界值为≥7.5 d。228例（100%）均在局部麻醉下行纤维支气管镜异物术成功取出异物，226例为1次性取出（99.1%），术中术后未出现明显并发症。结论　婴幼儿是气管支气管异物的高发人群，以植物性异物多见。植物类异物残留易造成气管内膜肉芽形成，病程越长，肉芽形成风险越高。应避免婴幼儿喂食坚果类食物，同时早期识别、 正确诊断并选用适宜的手术方式是预防异物吸入和治疗的关键。

关键词: 气管支气管异物, 肉芽, 支气管镜术, 儿童

Abstract:

Objective　To explore the clinical characteristics，diagnosis and treatment of tracheobronchial foreign body in children and analyze the risk factors for granuloma formation. Methods　A retrospective analysis of 228 children diagnosed with tracheobronchial foreign body was carried out，who were treated between January 2011 and December 2017，and the binary Logistic regression on risk factors of secondary airway intimal granulation after tracheobronchial foreign body was done.Results　The high incidence age of tracheobronchial foreign body in children was 1～3 years old（76.3%），and the ratio of male to female was 2.3∶1. The plant foreign bodies were the main proportion（82.9%），and the foreign bodies in left lung（52.6%） was slightly higher than in the right lung（39.5%）. Endotracheal granulation（74.4%），pneumonia（76.3%） and emphysema（51.3%） were the most common complications of tracheobronchial foreign body. The type and the remaining time of foreign body were the independent risk factor for the formation of endotracheal granulation（P＜0.01）. The longer the disease duration，the greater the risk of granulation formation（P＜0.01）. The ROC curve showed that the remaining time of foreign bodies could be used as a reliable indicator of endotracheal granulation，critical values of the independent correlation factor was the course of disease more than 7.5 d. All the foreign bodies in 228 cases（100%） were successfully removed by fiberoptic bronchoscopy under local anesthesia，226 cases of 1-time take-out（success rate 99.1%），and no obvious complications occurred during and after surgery. Conclusion　Children aged from 1 to 3 years old are the high incidence of respiratory foreign body，and plants are more common. Plant foreign body residue is prone to endotracheal granulation，and the longer the course，the higher risk the granulation. Avoiding feeding infants nuts，early identification and correct diagnosis，and choosing the suitable operation method is the key to preventing and treating foreign body inhalation.

Key words: tracheobronchial foreign body, granuloma, bronchoscopy, child