探讨角膜铁质异物剔除术的时机及治疗方法

目的探讨角膜铁质异物剔除的时机和治疗方法。方法角膜铁质异物通过1%地卡因眼液表麻后,用1ml一次性注射针头在裂隙灯显微镜下应用无菌操作技术剔除角膜深、浅层异物及锈斑。结果本组手术均获成功。术中发现在角膜未被感染或异物进入角膜后使用过抗生素眼药水、眼药膏者,即使异物进入角膜>5d,铁质异物也很容易被整块剔除,组织损伤小,无一例继发感染,减少了薄翳生成,效果满意。结论裂隙灯显微镜下取角膜铁质异物清晰、安全、彻底,有效的护理干预及规范的操作程序、严格的无菌技术是手术成功的保证。     

Case of impacted subglottic metallic foreign body removal without tracheostomy through an endotracheal tube

A foreign body in the upper airway can cause serious morbidity and mortality, especially in pediatric patients. This case report describes an innovative way to remove an impacted foreign body distal to the vocal folds through an endotracheal tube without tracheostomy.     

Nasal foreign body removal

Patients with nasal foreign bodies often present to the Emergency Department (ED) for removal. In most cases, successful removal can be performed by the Emergency Physician (EP) using a variety of simple techniques. The EP should be familiar with multiple procedural techniques as a significant number of patients will require multiple attempts and techniques for removal of the nasal foreign body. This article reviews the more common techniques for removal, and provides specific technical tips, indications and contraindications for each technique.     

90°针头异物剔除器在角膜铁质异物中的应用效果

目的探讨自制90°针头异物剔除器在角膜铁质异物中的应用效果。方法选取2015年8月-2016年10月的272例质异物患者,将患者按随机数字表法分为2组,每组136例。对照组采用异物针进行角膜铁质异物剔除,改进组采用自制90°针头异物剔除器进行角膜铁质异物剔除。治疗结束后,比较2组患者异物一次性剔除率及平均的异物剔除时间。结果治疗组患者角膜异物一次性剔除率明显高于对照组(χ2=0.01,P0.05);治疗组患者平均的异物剔除时间明显低于对照组(t=14.73,P0.05)。结论 90°针头异物剔除器治疗角膜铁质异物具有一次性异物剔除率高及剔除时间短等优点,值得临床推广应用。     

Deflate to Extricate: A Technique for Rectal Foreign Body Removal of Inflatable Ball

Background

Rectal foreign bodies are commonly encountered in the emergency department (ED). Three techniques are well described in literature, including using a Foley catheter, “scooping” the object out, or grasping the object directly with ring forceps. We present a novel extraction method for an inflatable foreign body.

Nasal Magnetic Foreign Body: A Sticky Topic

Background: Magnetic earrings are becoming a popular item for both adults and children. In recent years, there have been case reports describing how two magnetic rings become affixed to the nasal septum. Discussion: We report the use of two cardiac pacemaker magnets and two micro polypus forceps to remove the magnetic rings via induced magnetism. Conclusions: The use of magnetized instruments demonstrates a safe and effective way to remove impacted magnetic foreign bodies from the nose.     

显微眼内窥镜在后段眼内异物取出术中的应用

目的探索显微眼内窥镜在后段眼内异物取出及玻璃体切除术中的应用。方法将2005年7月-2006年3月38例眼内异物患者分为试验组（15例）及对照组（23例）。试验组采用显微眼内窥镜下完成对外伤性视网膜玻璃体病变等的处理及眼内异物的取出;对照组采用显微镜直视下行常规玻璃体切割及眼内异物取出术。结果试验组术后角膜透明度及眼压恢复、视力提高及视网膜复位等情况均优于对照组;异物取出情况、手术时间和并发症两组无差异。结论在观察困难或异物处于极周边时应用显微眼内窥镜,能够在手术中直接取出眼内各个部位异物,及时发现视网膜裂孔并同时行抗青光眼手术,减少对角膜材料的依赖和对角膜的损伤,为及时、准确和安全地手术提供了条件。     

保留自主呼吸下小儿支气管异物取出术麻醉方案优化

目的优化保留自主呼吸下小儿支气管异物取出术的麻醉药物组合。方法选取我院2018-10/2020-10期间硬质气管镜下支气管异物取出术患儿120例,年龄0~6岁,以患儿入手术室顺序抽取随机数字表法分为对照组(P组,n=60)和研究组(M组,n=60)。两组患儿的诱导均采用静注丙泊酚、吸入七氟醚并联合气道表麻的方式,自诱导后10 min待呼吸平稳及脑电双频谱指数(BIS)值稳定于40~60时停止吸入七氟醚,随后置入硬质镜开始手术。P组诱导时静注芬太尼1.5μg/kg,并持续泵注丙泊酚12 mg/(kg·h)至术毕;M组自诱导起泵注右美托咪定3μg/kg的负荷量,并持续泵注丙泊酚6 mg/(kg·h)和瑞芬太尼0.15μg/(kg·min)至术毕。记录入室时(T 0)、诱导毕准备置镜前(T 1)、硬镜置入时(T 2)、异物钳夹时(T 3)、苏醒期(T 4)、清醒时(T 5)的生命体征、手术医生满意度评分及并发症情况。结果除T 1及T 5其余各时点呼吸频率(RR)M组均高于P组(P<0.05);T 1及T 3脉搏血氧饱和度(SpO 2)M组高于P组(P<0.05)。M组手术医生满意度评分值高于P组(P<0.05)。术中屏气或呛咳例数、呼吸暂停例数、SpO 2下降例数及体动例数M组均低于P组(P<0.05)。结论硬质气管镜下小儿支气管异物取出术中优化的联合用药方案可明显降低术中并发症。     

裂隙灯眼前段处理系统在角膜异物中的应用及护理

目的探讨裂隙灯眼前段处理系统在治疗角膜异物中的应用及护理。方法将120例患者随机分为对照组（n=60）和实验组（n=60）,对照组采用传统检查治疗方法。实验组应用配置佳能Power ShotA720IS型数码照相机（1200万像素）SLM型裂隙灯显微镜检查角膜异物的位置,并在不同角度下进行照相（放大倍率×10,×16,×20）。结果实验组患者对医护人员信任度和满意度高于对照组,差异有统计学意义（P〈0．05）。结论裂隙灯眼前段处理系统的应用为角膜异物伤的患者提供直接定性依据,给患者了解自身病情带来便利,同时进行相关的护理,达到较理想的效果。     

恩纳用于小儿气管异物取出术的临床观察

目的 :小儿气管异物取出术常因小儿不能耐受支气管镜而出现不同程度的屏气和缺氧。本研究目的在于观察恩纳 (EMLACream ,EC)用于小儿气管异物取出术的有效性和安全性 ,以及是否能降低术中小儿屏气和缺氧的发生率及程度。方法 :30名患气管异物的小儿随机分为恩纳组和对照组。恩纳组在支气管镜表面均匀涂抹EC 0 2～ 0 3g。术中记录患儿屏气程度、最低SpO2 的值及追加氯胺酮的例数。术后手术医生对麻醉满意度评分。结果 :恩纳组患儿的屏气程度明显轻于对照组 ,中度以上屏气恩纳组有 4人 (2 6 7% ) ,对照组有 1 1人(73 3% ) (P <0 0 5 )。术中最低SpO2 恩纳组 (93%± 5 % )明显高于对组 (83%± 1 2 % ) ,(P =0 0 1 2 ) ,其中对照组SpO2 最低降至 5 4 % ,而恩纳组最低降至 83%。术中追加氯胺酮的例数恩纳组明显少于对照组 (3人vs1 1人 )(P <0 0 5 )。术后手术医生对麻醉的满意度评分恩纳组 (90 4± 8 8)明显高于对照组 (79 7± 1 3) (P =0 0 2 1 )。结论 :本研究表明 ,EC可安全有效地用于小儿气管异物取出术 ,能明显降低术中小儿屏气和缺氧的发生率及程度 ,减少麻醉药用量     

丙泊酚、瑞芬太尼复合阿曲库铵加高频喷射通气在小儿气管异物取出术的应用

目的研究丙泊酚、瑞芬太尼复合阿曲库铵加高频喷射通气用于小儿气管异物取出术的临床效果。方法随机选择行气管异物取出术患儿40例，分为丙泊酚、瑞芬太尼复合阿曲库铵（P组）和氯胺酮联合r-羟基丁酸钠（R组）各20例。两组均采用高频喷射通气，比较其手术时间、苏醒时间、术中术后心率（HR）、血氧饱和度（SpO2）、血压（BP）的变化及发生呛咳、屏气呼吸暂停、支气管痉挛的次数、最低SpO2。结果两组HR、SpO2、BP和手术时间无显著差异，但R组置镜、退镜时屏气，术中屏气、呛咳、支气管痉挛和最低SpO2的例数等明显高于P组（P〈0．05），且苏醒时间较P组明显延迟（P〈0．05）。结论丙泊酚、瑞芬太尼复合阿曲库铵加高频喷射通气是小儿气管异物取出术的的一种较为安全可行的麻醉方法。     

经镇静/麻醉胃镜异物取出术在精神病患者中的应用

目的总结镇静/麻醉胃镜异物取出术在精神病患者应用中的治疗体会。方法回顾性分析2006年10月-2017年10月该院消化内镜中心通过镇静/麻醉胃镜诊治的上消化道异物急诊及病房精神病患者78例的临床资料。结果上消化道异物顺利取出78例,镇静/麻醉胃镜治疗前、治疗中及治疗后患者的生命体征[血压(BP)、心率(HR)、呼吸(R)、动脉血氧饱和度(SaO_2)]均平稳。结论对于精神病患者的上消化道异物的治疗可通过镇静/麻醉胃镜下的异物取出术治疗,该术具备成功率高、安全性好的特点。     

胃镜治疗小儿上消化道异物45例分析

目的 探讨成人胃镜治疗儿童上消化道异物的临床疗效。方法 采用Olympus GIF-XQ 240胃镜和相关器械对45例误吞异物的儿童进行上消化道取异物治疗。结果 小儿上消化道异物34例取异物获成功，术中、术后无1例出现并发症。结论 成人胃镜治疗儿童上消化道异物的费用低、疗效好、安全性高，值得临床推广。     

Prevalence,Clinical Features and Management of Pediatric Magnetic Foreign Body Ingestions

Background

Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall.

Study Objectives

We aimed to identify the prevalence, clinical presentation, and management of magnetic FB ingestions at our tertiary care institution.

Methods

We performed a retrospective chart review of medical records of patients presenting to the pediatric Emergency Department (ED) or admitted to the hospital with FB ingestions from June 2003–July 2009. From those cases, patients with magnetic FB ingestions were identified.

Results

During the study period, 337,839 patients presented to the ED; 38 cases of magnetic FB ingestion were identified (prevalence 0.01%). Abdominal radiography was obtained in all cases. Ingestion of a single magnet occurred in 30 of 38 cases (79%). Of those, 4 patients underwent endoscopic removal due to signs of FB impaction in the esophagus or pylorus; no complications were noted. Ingestion of multiple magnets (range 2–6) occurred in 8 of 38 cases. Four of the 8 patients with multiple magnetic FBs (50%) presented with signs of peritonitis and required operative repair of multiple intestinal perforations. No deaths were identified.

Conclusion

Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions.     

幼儿支气管异物取出联合肺泡灌洗术的护理配合

目的探讨纤维支气管镜下幼儿支气管异物取出联合肺泡灌洗术的护理配合。方法对本院38例幼儿支气管异物经纤维支气管镜行异物取出肺泡灌洗术的术前、术中护理配合进行回顾性分析总结。结果 37例成功取出异物,1例难以取出,转上级医院治疗,异物取出成功率达97.37%。结论完善术前准备,做好术中体位固定,严密气道管理,及时配合进退镜及肺泡灌洗,是提高手术成功率、减少并发症的关键。     

Small Rare Earth Magnets Adhered to Pharyngeal Tissue in a Pediatric Emergency Department Patient

BackgroundSmall rare earth magnets pose a known health risk to children and many cases of ingestion and aspiration with associated complications have been described. More unusual, but also seen in children, are retained foreign bodies in the oropharynx that require extraction.Case ReportWe present the case of a 3-year-old boy with persistent left-sided sore throat 1 h after ingestion of several 3-mm spherical rare earth magnets. No foreign bodies were visible in the oropharynx on examination; however, a chest radiograph revealed two adjacent magnets within the lower pharyngeal space, as well as four magnets linearly clumped within the small intestine. The patient was taken to the operating room, where visual inspection under general anesthesia revealed two magnets adhered to the pharyngoepiglottic folds (one on the laryngeal surface and one on the glottic surface). They were removed in full without issue, preventing aspiration.Why Should an Emergency Physician Be Aware of This?Given the recent increase in incidence of rare earth magnet ingestion, emergency providers ought to be aware of the risks and complications associated with magnetic foreign body ingestion in children and the workup and considerations involved in their removal. Providers should also advocate for improved safety controls of these products, which have been found to be effective in the past.     

Management of foreign bodies in the ear, nose and throat

This article presents a summary of the common foreign bodies (FB) and a practical approach to diagnosis and management. Removal of FB requires good lighting, a cooperative or fully restrained patient and a gentle approach by the clinician. An accurate diagnosis of the FB should be made prior to attempts to remove it and most, if not all FB could be safely removed the following day under better lighting conditions, sedation or anaesthesia in a fasted patient by a more senior clinician.     

裂隙灯下角膜异物剔除术病人的围术期护理

[目的]总结裂隙灯下角膜异物剔除术病人的围术期护理措施。[方法]回顾性分析1860例(1900眼)裂隙灯下角膜异物剔除术病人的临床资料。[结果]本组病人角膜异物一次性取净1780例,经2次除锈取净80例;术后均愈合,残留薄翳70例;无一例发生术后感染及角膜穿孔等并发症。[结论]加强裂隙灯下角膜异物剔除术的围术期护理是手术成功的保证。     

急诊医生用床边B超在浅表软组织异物取出中的价值

目的:总结急诊医生主导床旁B超声技术在浅表异物取出术中的应用价值。方法:采用便携式迈瑞型彩色超声诊断仪BD177921对65例外伤后浅表软组织内异物存留患者行超声诊断定位,引导手术实施,探取异物。结果:结合患者病史,B型超声在异物存留患者的诊断定位中准确率高,能引导手术取出异物。结论:急诊医生主导床旁B超声技术方便、安全、高效,在浅表软组织内异物的诊断定位及引导手术取出异物中有重要的临床价值。