Foley管法在取出儿童圆钝食管异物中的价值和安全性

目的探讨Foley管法取儿童食管异物的有效性和安全性。方法回顾性分析新疆医科大学第一附属医院耳鼻喉科2010年5月-2013年5月17例儿童用Foley管法取出食管异物的操作方法、效果及并发症。结果 17例食管异物中16例为金属异物,1例为扁平石头。16例金属异物当中硬币类11例,金属钮扣2例,钮扣电池1例,装饰环1例,吊坠1例。异物停留位置在食管第二狭窄处7例,胸廓入口处6例,食管第一狭窄处4例。通过Foley管顺利取出16例,取出失败并掉入胃内2d后排出体外1例。所有患儿均未发生进食时疼痛、出血或呼吸困难等并发症。结论 Foley管法安全、高效、经济、快速,适于取儿童钝圆、扁平食管异物。     

Removal of esophageal foreign bodies with a Foley balloon catheter under fluoroscopic control.

Between 1982 and 1985 removal of a nonorganic, smooth, radiopaque foreign body in the esophagus with a Foley balloon catheter under fluoroscopic control without sedation was attempted in 38 children. An ultra-low-dose fluoroscopic unit was used. In 35 children the foreign body (a coin) was either easily removed (in 29 cases) or advanced into the stomach (in 6). No complications of the procedure were observed. In three children the foreign body could not be removed by this means; it was subsequently removed by endoscopy (in two cases, both of coins) or esophagotomy (in two cases, both of coins) or esophagotomy (in one, of a stone). When carefully performed, removal of blunt, recently ingested esophageal foreign bodies with a Foley catheter under fluoroscopic control is a safe mode of treatment.     

Hypopharyngeal and oesophageal foreign bodies

Foreign bodies in the food passages are quite common in Jos Community. Majority of 119 cases seen over a period of four years were children 92.4% and a coin was the commonest foreign body (86.5%). The site of lodgement of the foreign body was hypopharynx and abdomen in 11 cases each while 97 were held in oesophagus, mainly in its upper part. Removal of the foreign body by oesophagoscopy was difficult in patients who presented late. The coins formed a pouch in posterior oesophageal wall in six cases while their anterior surfaces got discoloured in 14 cases causing difficulty in their identification. Besides coins in children and dentures in adults, nine patients accidently swallowed a wide variety of foreign objects of different shapes and sizes. Management of such cases has been discussed.     

小儿上消化管异物30例无痛胃镜治疗分析

目的:评价小儿上消化管异物行无痛胃镜下取出有效性及安全性。方法:对30例小儿消化道异物在氯胺酮静脉麻醉下行胃镜取出,于术前、术中及术后监测MAP、R、P和SaO2,记录治疗开始至清醒的时间及不良反应。结果:28例上消化管异物被成功取出,术前、术中及术后MAP、R、P和SaO2无显著性差异(P>0.05),总治疗过程约20min,患儿无明显不适主诉,无严重并发症发生。结论:小儿上消化管异物的无痛胃镜下取出安全有效。     

Foley管取出小儿食管异物14例临床体会

食管异物为耳鼻咽喉科常见急诊之一.传统的食管异物取出方法为硬性直食管镜法,其适用范围广,但要求有一定的技术及麻醉配套才能进行.笔者单位自2004年2月～2006年2月采用Foley管取出小儿食管光滑异物14例.     

Foley管法治疗小儿食管异物56例临床分析

目的：探讨治疗小儿食管异物安全、有效的办法。方法：对用Foley管法取小儿食管异物56例进行回顾性分析。结果：56例中用Foley管法顺利取出异物53,其中一次成功48例,平均住院4．6h,平均医疗费用267．6元。结论：Foley管法取小儿钝圆形食管异物勿需全麻、且安全、有效、经济、具有较高的临床应用价值。     

Inhaled foreign bodies in children

We review a series of 115 children who attended the Royal Children's Hospital in Melbourne between 1979 and 1982 with the diagnosis of inhalation of a foreign body, or in whom a foreign body was found at bronchoscopy. Children between the ages of one and three years were the most commonly affected (75%) and boys outnumbered girls in the ratio 3:2. In 16% of cases the child did not present until more than one week after inhaling the foreign body. A peanut was the most common foreign body found (52% of cases), and it seems that many parents are still unaware that peanut ingestion can be hazardous in very young children.     

The management of oesophageal foreign bodies and their complications

Five patients are described to demonstrate some of the possible clinical courses which may follow the ingestion of a foreign body. The management of such patients is discussed and evidence presented to support the case for detailed investigation, treatment and follow up.     

芬太尼复合丙泊酚麻醉在小儿支气管异物取出术中的应用效果

目的:分析芬太尼复合丙泊酚麻醉在小儿支气管异物取出术中的应用价值。方法:将66例行支气管异物取出术的患儿根据麻醉方法分为两组,对照组32例行丙泊酚联合氯胺酮麻醉,观察组34例行丙泊酚复合芬太尼麻醉,比较两组麻醉效果、心率及血压变化情况、不良反应发生情况。结果:两组下颌松弛理想、麻醉效果满意、声门开放率、肢体反应与气道发生发生率比较组间均有明显差异(P<0.05)。术中观察组心率与血压波动较小,对照组心率与血压波动明显。组间对比显示,在麻醉后、插镜时、取镜时、手术完成时观察组心率明显低于对照组(P<0.05),收缩压与舒张压明显高于对照组(P<0.05);观察组手术时间明显短于对照组,患儿术后苏醒时间(26.31±4.58)min明显短于对照组(42.75±4.62)min,不良反应发生率2.94%明显低于对照组的21.88%(P<0.05)。结论:芬太尼复合丙泊酚麻醉用于小儿支气管异物取出术,可维持术中患儿心率及血压的稳定,降低不良反应发生风险,且可缩短患儿苏醒时间。     

罗库溴铵联合高频控制通气用于婴幼儿气管异物取出术

目的 研究罗库溴铵联合高频控制通气用于婴幼儿气管异物取出术的麻醉效果.方法 42例ASA I～Ⅱ级行气管异物取出术的患儿,随机分为罗库溴铵组(R组)和对照组(C组),每组21例.R组静脉注射咪唑安定、氯胺酮、罗库溴铵麻醉,消除自主呼吸,插入支气管镜后经侧孔高频控制通气;C组静脉注射咪唑安定、氯胺酮、芬太尼、丙泊酚麻醉,保留自主呼吸,插入支气管镜后经侧孔辅助通气.术中连续监测心电图(ECG)、心率(HR)、呼吸(RR)、脉搏血氧饱和度(SpO2),记录低氧血症、呛咳、气道痉挛等不良反应的发生次数、手术时间、苏醒时间及苏醒期并发症.结果 R组术中不良反应及苏醒期并发症发生率较C组明显降低(P<0.05),手术及苏醒时间较C组明显缩短(P<0.05).结论 在婴幼儿气管异物取出术中,采用罗库溴铵联合高频控制通气较保留自主呼吸更能减少术中缺氧等不良反应的发生,缩短手术时间,苏醒更快且平稳. Abstract： Objective To investigate the efficacy of rocuronium combined with high-frequency ventilation for anaesthesia of airway foreign bodies removal in children.Methods Forty-two ASA Ⅰ-Ⅱ children undergoing airway foreign bodies removal were randomly divided into rocuronium group(R)and control group(C),there were 21 cases in each group. In group R,the children were anesthetized with intravenous midazolam,ketamine,rocuronium and high-frequency mechanically ventilated after bronchoscope intubation. In group C, the children were anesthetized with midazolam,ketamine,fentanyl and assistantly ventilated after bronchoscope intubation. ECG, HR,MAP,RR,SpO2 were continuously monitored. Adverse events(hypoxia, bradycardia,cough,airway convulsion), duration of operation, the time of recovery, postoperative complications (nausea,vomiting,agitated,airway convulsion)were recorded.Results The incidence of adverse events during operation and postoperative complications were significantly lower in group R than that in group C. The duration of operation and the time of recovery were significantly shorter in group R than that in group C.Conclusions Rocuronium combined with high-frequency ventilation can reduce adverse events during operation and result in shorter duration of operation,rapid recovery and fewer postoperative complications.     

小儿呼吸道异物治疗846例

目的探讨小儿呼吸道异物的最佳治疗方法。方法对呼吸道异物患儿846例中的827例,急诊全麻下行支气管镜检查术及异物取出术,感染较重或合并皮下气肿气胸19例患儿先行对症消炎后再行手术。结果846例中一次手术成功率为99.53%（842/846）,4例一般情况不良,行支持消炎治疗后二次手术成功。无1例气管切开、开胸、死亡病例。结论小儿呼吸道异物的取出要选择最佳的手术时机和麻醉方法,诊治及时,可获得较好疗效。     

颌面部软组织金属异物手术治疗体会

颌面部系人体外露部位，无论平时或战时受损伤的机会都很高，金属异物存留的病例也较常见，治疗上比较困难，现将我院2006年治疗的12例不同类型金属异物存留的经验报告如下。