儿童气道异物21例误诊分析

目的探讨儿童气道异物误诊的原因，减少儿童气道异物的误诊。方法回顾性分析117例儿童气道异物中误诊的21例病例的临床特点及胸部X线检查（呼吸相胸部平片度透视）和冠状位CT表观。所有病例中除1例经胸部手术取出异物并作肺叶切除外，其余病例均经支气管内窥镜取出异物证实。结果21例临床误诊分别为毛细支气管炎6例，支气管哮喘3例，上感4例，肺炎8例，其中有异物吸入史9例（42．86％），无明确异物吸入史12例（57．14％）。X线表现异常者18例，无异常表现者3例。21例CT表现均显示气道内异物的存在。结论对反复咳嗽、吼喘经抗炎治疗无效、X线表现为肺炎伴一侧性肺气肿的忠儿，即使无异物吸入史，也应考虑到气道异物的可能。对X线检查阴性的患儿，如果临床强烈提示有异物吸入史，应建议作气道冠状位CT扫描。

Analysis of misdiagnosis in children with air way foreign bodies

Objective To explore misdiagnostic causes of air way foreign bodies in children in order to reduce misdiagnosis rate.Metheds Retrospective study was carried out on 21 misdiagnosis patients with tracheobronchial foreign bodies,including their clinical manifestations,chest X-ray examination,the coronal CT scan.Results Among 21 misdiagnosis cases,there were 6 cases of bronchiolitis,3 cases of bronchial asthma,8 cases of pneumonia,4 cases of upper respiratory tract infection.Nine cases had a history of foreigh body aspiration.X-ray findings were abnormal in 18 patients and the coronal CT scan showed air way foreign bodies.Conclusion If there is no foreign bodies aspiration,air way foreign bodies should be considered to the patients who has recurrent cough,wheezing being no effective with intravenous antibiotics and X-ray shows pneumonia and bilateral pulmonary emphysema.The coronal CT scan should be suggested for doubtful case who complains a history of foreigh body aspiration but has no abnormal X-ray finding.