小儿气管支气管多发性异物求台体会

报告救治３２例小儿气管支气管多发性异物的体会。认为：小儿气管支气管多发性异物有明显增多的趋势，且多为植物性的异物，其临床经过险恶。当围术期出现呼吸道梗阻时，就立即插入支气管镜取异物；迅速建立有效通气道是挽救患儿生命的可靠措施；另外，须常规检查“健侧”支气管，以防止多发笥异物的遗漏。     

癫痫发作伴发支气管异物一例

患者男，4岁，体重20k。因癫痫大发作，呛入熟花生米1天入院。患儿出生时因脐带绕颈，滞产，造成缺血性脑病，出生后常发生抽搐，癫痫小发作，大约每天发作5、6次，间断大发作。长期服抗癫痫药，痴呆面容，流涎，四肢软瘫。本次发病因进食熟花生过程中突然癫痫大发作，牙关紧闭，四肢抽搐，呛入整口的熟花生。当时有剧咳，10min后抽搐，咳嗽缓解。第二天来诊，神志清，癫痫小发作，呼吸稍促，无紫绀，右肺呼吸音明显减弱，左肺呼吸音增强。入院诊断癫痫发作并右支气管异物。请儿科会诊控制癫痫发作，使用四联药(卡马西平、丙戊双镁、鲁米那、苯妥英钠)后，癫痫仍小发作，因考虑支气管异物有可能是癫痫持续发作的一个原因，故当日行气管镜异物取出术。     

儿童支气管笔头类异物28例

笔头类异物是指学龄儿童常用的自动铅笔、圆珠笔最前端呈圆锥形、并和笔杆有螺纹连接的部分，可以旋转拧下。笔头类异物是近年来学龄儿童最常见的异物类型，手术难度较大。我科自1996～2002年收治28例，报告如下。     

纤维支气管镜取气管支气管异物3例

例 1 　 男 ,8岁。误吸塑料哨笛后咳嗽、呼吸不畅 3 d,于 1 997年 1 0月 3 0日入院。体检 :体温3 6 .4℃ ,呼吸 2 0次 /min,呼吸平稳 ,深呼吸时胸腔内发出哨鸣音 ,右肺呼吸音明显减弱。X线胸透 :深呼吸时见纵隔摆动 ,右下肺透光度增强。诊断 :右支气管异物。家属带来与吸入物相同的塑料哨笛一只 ,为白色圆管状 ,长 1 3 mm,一端外径 8mm,另一端略大 ,且有一环形外突的唇缘 ,外径 1 0 .5 mm,管内径 3 .5 mm,内卡有一片可取出的簧片。即取支气管镜及异物钳进行模拟试取 ,哨笛内孔可通过纤维支气管镜活检钳。于当日在全麻下行支气管异物取出术 …     

潜窥镜在小儿支气管异物取出术中的应用

支气管镜检查作为治疗小儿支气管异物的有效手段已广泛应用于临床。近 3年来关于支气管异物漏诊、误诊、支气管异物残留的报道逐渐增多 ,较大支气管异物行气管切开或开胸取异物的病例也时有报道。我科自 1 992～ 2 0 0 1年作支气管镜检查术治疗小儿支气管异物 1 0 4 8例 ,其中 82 6例同时应用潜窥镜检查 ,成功地避免了以上问题的出现。现报告如下。1　资料与方法1 .1 　 临床资料本组 1 0 4 8例 ,其中男 682例 ,女 366例 ;年龄3个月～ 3岁 785例 ,>3～ 8岁 1 77例 ,>8～ 1 4岁86例 ,平均 2 .76岁。花生米异物 437例 ,西瓜籽2 81例 ,葵花籽 1…     

支气管口香糖异物1例

患儿，女，6岁。主因吃口香糖时呛咳后咳喘3h于2002年12月7日入院。体检：体温37．6℃，双肺呼吸音粗，左下侧呼吸音明显减低，心腹(-)。胸部透视见纵隔摆动，左肺下叶不张。禁食后行全身麻醉支气管镜检查术，见喉气管(-)，于左支气管下叶口上发现白色异物，伴大量痰液，将下叶口完全阻塞，吸引管当即阻塞，异物钳取之，如胶状粘     

儿童气管支气管异物的并发症及处理

目的分析儿童气管支气管异物的并发症及探讨并发症处理方法。方法回顾分析2008年1月～2010年4月湖南省儿童医院收治的1020例气管支气管异物的治疗经过。结果 1020例儿童气管支气管异物中并发支气管肺炎935例、肺不张478例、肺气肿480例、皮下气肿25例、纵隔气肿6例、皮下及纵隔气肿5例、气胸3例,其中230例患者合并两种及两种以上并发症。2例气胸患者,在行胸腔闭式引流待肺复张至80%后取出异物,另1例气胸及其他并发症未做特殊处理,在异物取出后经抗炎治疗3～5 d后恢复正常。结论支气管肺炎是气管支气管异物最常见的并发症,气胸是危重及少见的并发症。气管支气管异物的并发症的处理最为重要的是将异物取出,伴明显呼吸困难则需紧急处理;严重气胸需行胸腔闭式引流,待肺复张后取出异物,其他并发症未做特殊处理在异物取出后得到恢复。     

气管,支气管异物取出术1268例报告

报告１９９０￣１９９５年１５年间气管、支气管异物取出术１２６８例，无一例术中、术后死亡。就诊断、术前准备、手术时机、麻醉方法、手术方法、特殊异物的处理、术中窒息的处理、并发症的处理等方面进行了讨论。     

纤维支气管镜下取出支气管特殊异物的体会

支气管异物一般在硬性支气管镜下取出,有些特殊的支气管异物,有时难以经过硬性支气管镜取出.我们在纤维支气管镜下为5例取出支气管内特殊异物,报道如下.     

成人气管支气管异物43例临床分析

摘要：目的探讨成人气管支气管异物的临床特点及合适的手术方法。方法回顾性分析２０10年１月~２０１5年12月福建医科大学附属龙岩第一医院耳鼻咽喉科收治的成人气管支气管异物43例的诊治过程。根据异物特点,采取合适的手术方式取出气管支气管异物,手术中经麻醉直接喉镜下取出2例、电子支气管镜下取出13例、硬质支气管镜下取出22例、经气管切开处联合硬质支气管镜取出6例。结果43例均成功取出异物,无失败病例,成功率100％,无死亡病例。结论快速有效诊断,术前评估,实施合适的手术方法对成人气管支气管异物的治疗至关重要。     

Seasonal correlation and causal analysis of the incidence of bronchial foreign bodies in children

Objective

To explore the seasonal correlation of the incidence of bronchial foreign body.

Method

Conduct retrospective analysis on clinical data of 1819 cases with bronchial foreign bodies in our hospital within an eight-year period (from January 2005 to January 2012), with cases classified into 12 groups by admission time (calculated by the Gregorian calendar in months, from January to December) and 4 groups by the Gregorian calendar in seasons (spring from March to May, summer from June to August, autumn from September to November, and winter from December to February), and observe whether the number of inpatients indicates any monthly or seasonal correlation.

Results

The months of November and December indicated the highest number of inpatients, with 263 cases and 274 cases, which accounted for 12.7% and 13.2% of all reported cases, respectively. On the other hand, June and July had the lowest number of inpatients, with 96 cases and 75 cases, which accounted for 4.6% and 3.6%, respectively. Based on season, 749 cases were admitted in autumn, accounting for 35.1%; 636 cases were admitted in winter, accounting for 29.8%; 474 cases were admitted in spring, accounting for 22.2%; and 275 cases were admitted in summer, accounting for 12.9%. The number of inpatients was periodic, with 12 months as a cycle, and significant difference (P < 0.01) was determined by comparing the numbers of inpatients in winter and spring and those in summer and spring.

Conclusions

The number of child in patients with bronchial foreign bodies is monthly periodic, with 12 months as a cycle, and respectively reaching the peak in November and December, and the valley in June and July; the seasonal characteristic was apparently related to the monthly characteristic, with the numbers of inpatients in autumn and winter each year being significantly higher than in the spring and summer, and the incidence showing apparent seasonal correlation. The results allow for the proposal of relevant precautionary measures against bronchial foreign bodies in children.     

The complimentary role of diagnostic and therapeutic endoscopy in foreign body aspiration in children

Objective

To review the importance and benefits of flexible bronchoscopy and rigid bronchoscopy in airway foreign body inhalation in children. Prompt diagnosis will lead to safer outcomes when both types of endoscopy are employed within the operating room setting.

Methods

Retrospective review of all cases of foreign body inhalation seen and treated in our Department between July 1986 and December 2010.

Results

Three-hundred and ten children were admitted to our Department from Pediatric Emergency Room for a suspected foreign body inhalation. All patients with suspected FB inhalation underwent bronchoscopy. Of 310 evaluations of tracheobronchial tree performed at our Department, 104 were negative, while an airway FB were observed and removed in 206 cases.

Conclusions

Rigid bronchoscopy under general anesthesia is an extremely accurate surgical technique to identify, localize and remove airway foreign body. In our experience, flexible bronchoscopy under total intravenous sedation and topical anesthesia is very useful in doubtful cases to absolutely exclude the presence of foreign body in upper airway tracheobronchial tree.     

小儿气管支气管异物312例

目的 总结小儿气管支气管异物的诊断、治疗及围手术期并发症防治方面的经验,提高诊治水平,降低围手术期并发症的发生.方法 回顾性分析以气管支气管异物收住院312例的病历资料,其中有1例张开的别针和1例大头针异物因位置特殊转外院胸科开胸取出,7例术前将异物咳出,8例病情危急在无麻下直接取出异物,其余均在全身麻醉下用硬质支气管镜取出异物. 结果 312例中支气管异物左侧123例,右侧129例;气管60例.其中异物取出后麻醉苏醒期出现窒息26例,经面罩加压给氧抢救后好转;苏醒回病房后出现窒息1例,回手术室再次支气管镜下取出遗留部分异物后好转;术后考虑脑水肿转综合医院小儿科1例,治疗好转;因窒息时间太长,到医院后抢救无效死亡1例;其余病例均手术顺利,恢复好.结论 气管支气管异物发病以男性多见,以1岁左右年龄段高发,异物种类以花生和瓜子最多,异物位置左右支气管无明显差异,术前及时明确诊断、术中仔细操作及术后严密观察是降低围手术期并发症的关键.     

Lung recovery after rigid bronchoscopic removal of tracheobronchial foreign bodies in children

OBJECTIVE: Foreign body (FB) aspiration affects lung function and often results in pulmonary complications. We have assessed the clinical and radiological predictors of delayed lung recovery after rigid bronchoscopic removal of airway FBs. METHODS: The demographic data, clinical presentations, treatment profiles, pre- and post-treatment chest radiographs, and treatment outcomes were reviewed retrospectively in 104 pediatric patients who underwent removal of tracheobronchial FBs by rigid bronchoscopy. The clinical and radiological factors predicting delayed (>or=5 days) lung recovery time were statistically analyzed by logistic regression. RESULTS: Preoperative chest radiographs showed infiltrates consistent with inflammation in 21 patients (20.2%). Successful bronchoscopic removal of all FB fragments was achieved in 100 patients (96.2%). Immediate postoperative aggravation was observed in 10 patients (9.6%). Mean post-treatment pulmonary recovery was 3.8 days. On univariate and multivariate analyses, preoperative inflammation, immediate postoperative aggravation, and unsuccessful removal of airway FBs were significant predictors for delayed lung recovery. The preoperative inflammatory and immediate postoperative chest radiologic findings were significantly correlated (p<0.001). CONCLUSIONS: Delayed lung recovery after rigid bronchoscopic removal of tracheobronchial FBs can be predicted by FB-induced inflammatory chest radiologic findings and the unsuccessful or complicated removal of airway FBs.     

Efficacy of manual jet ventilation using Manujet III for bronchoscopic airway foreign body removal in children

Objectives

To evaluate the efficacy of a manual jet ventilation device for bronchoscopic removal of foreign bodies in children.

Methods

360 children aged from 10 months to 12 years old undergoing rigid bronchoscopy for airway foreign body (FB) removal from February 2005 to June 2009 were included in the study. Patients were randomly divided into three groups of 120 patients per group (S, P and J). In group S, anesthesia was induced with propofol and γ-hydroxybutyrate sodium and maintained by intermittent bolus administration of propofol; the patients were breathing spontaneously throughout the procedure. In group P, anesthesia was induced with propofol (4-5 mg/kg), fentanyl (1-2 μg/kg) and succinylcholine (2 mg/kg). Mechanical ventilation was performed through the side arm of the rigid bronchoscope. In group J, the patient received propofol, fentanyl and succinylcholine as the same doses administered in group P, and manual jet ventilation was performed by using the Manujet III device. Condition for insertion of bronchoscope, occurrence of hypoxemia, successful rate of FB removal, the duration of the operation, the time of emergence and recovery from anesthesia, and perioperative complications (adverse events) were recorded.

Results

Groups P and J had significantly higher rates of successful bronchoscope insertion (P < 0.05), significantly higher success rates for FB removal (P < 0.05), and lower incidences of hypoxemia during intra- and post-operative periods when compared with group S. Perioperative complications were lower (P < 0.05), duration of operation was shorter, and emergence from anesthesia was faster (P < 0.05) in groups P and J when compared with group S. Incidences of hypoxemia were lower in Group J when compared with Group P (P < 0.05).

Conclusion

This study confirmed the safety and efficacy of performing manual jet ventilation with Manujet III in foreign body removal by rigid bronchoscopy in children.     

儿童支气管异物回顾性分析

目的：回顾性分析156例儿童支气管异物病例,总结其诊疗体会。方法对本组患儿的性别、年龄、首诊症状、异物种类、影像学检查、治疗结果、患儿家长文化程度等多个因素进行统计分析,总结诊疗体会。结果男女患儿比例为2.8：1,2岁以下患儿占总数的66.0％,首诊主要症状为反复发生呼吸道感染者69.23%,坚果类异物最为常见（73.1%）;影像学检查对诊断不具有特异性。结论异物吸入史是重要的诊断依据。如无此病史,肺部感染治疗无效或某一区域反复感染者应该考虑支气管异物的可能。提高家长对儿童意外伤害的预防知识是避免意外发生的关键所在。     

Foreign bodies in the tracheobronchial tree: A prospective study of fifty cases

Aspirated foreign bodies continue to present challenges to the otorhinolaryngologists—the major issues being accurate diagnosis and speedy and safe removal of the foreign bodies. Tracheobronchial foreign bodies are most common in the 1–3 year age group and are usually of vegetative origin. The most common signs and symptoms of tracheobronchial foreign bodies are cough, wheeze and decreased air entry on the affected side. Diagnostic bronchoscopy is recommended in all children presenting with a history of sudden onset of cough, choking spell, an unexplained acute wheeze, or a chronic pulmonary infection. The present study was undertaken to study the varied clinical presentations of tracheobronchial foreign bodies.     

老年支气管异物的诊断和治疗

目的：探讨老年支气管异物的诊断及治疗方法。方法：回顾性分析15例老年支气管异物的临床特点及有关文献资料,总结老年支气管异物的诊断和治疗方法。结果：15例老年支气管异物中有6例被误诊或漏诊;3例在表面麻醉,12例在表面麻醉加静脉复合麻醉情况下顺利取出异物,均无并发症发生。结论：老年支气管异物的临床表现常常不典型,多数患者X线胸片不能显示异物的直接表现,且异物吸人史常不明确,故易被误诊或漏诊。合适的麻醉方式是老年支气管异物成功取出的关键。     

带钳Hopkins潜窥镜在小儿肺段支气管异物中的应用

摘要：目的探讨带钳Hopkins潜窥镜在小儿肺段支气管异物取出中的临床应用。方法27例肺段支气管异物患者,其中5例为二次手术,以仿真支气管CT和纤维支气管镜诊断。全身麻醉下,从硬性支气管镜套入带钳Hopkins潜窥镜,Hopkins潜窥镜接电视监视系统,直视下将肺段支气管异物取出。结果27例患者均成功将异物取出,无开胸取异物、气管切开口取异物及死亡病例,5例二次手术患者中,1例患者术后出现气胸,行胸腔闭式引流,转ICU病房,其他患者无气胸、纵隔气肿等并发症发生。结论带钳Hopkins潜窥镜可在直视下钳夹并取出异物,提高小儿肺段支气管异物取出的精确性,避免了开胸取异物,减少了并发症及术后残留。     

高氧雾化吸入利多卡因在小儿支气管异物取出术中的应用

目的 比较小儿气管异物取出术时,采用高氧雾化吸入利多卡因表面麻醉法或丁卡因咽喉部喷雾法,何者更有利于抑制气道反射。方法 将拟行气管异物取出术的患儿随机分为两组,每组30例, 两组均采用静脉诱导麻醉,A组以利多卡因高氧雾化吸入,B组以丁卡因咽喉喷雾为气道表面麻醉,观察术中患儿MAP、HP、SPO2的变化以及不良反应的发生率。结果 术中两组的MAP、HP、SPO2差异有统计学意义(P<0.01)。A组屏气、呛咳、气道痉挛的发生率明显低于B组(P<0.01)。结论 高氧雾化吸入利多卡因可将表面麻醉剂吸入咽喉、气管、支气管,避免器械刺激引起的迷走神经反射,能更有效地抑制气道反射,使小儿气管异物取出术患儿的血流动力学更趋平稳。