西藏高海拔地区儿童气管支气管异物治疗经验

目的分析西藏高原地区儿童气管支气管异物的发病特点，总结适合高海拔地区儿童气管支气管异物的诊疗方法，以提高治疗效果和安全性，减少患者的死亡率。方法回顾性分析西藏军区总医院2008年1月~2014年5月收治的25例气管支气管异物患儿的治疗方法，治疗结果，总结西藏高海拔特殊地理环境中气管支气管异物的诊疗方案。结果25例患儿均全身麻醉加表面分段复合麻醉，其中12例行硬支气管镜治疗，10例取出异物，2例转低海拔内地医院，随诊取出异物。3例在直接喉镜下试取2例取出异物，失败的1例改用硬支气管镜取出。4例患者在纤维支气管镜下试取，1例取出，3例未取出，其中2例死亡。4例患者行气管切开，自气管切开处取出异物。2例转心胸外科行开胸手术取出异物。结论对于高原地区儿童气管支气管异物，快速准确的诊断，选择切实可行的治疗方案，可有效降低患者痛苦，减少并发症，降低患者死亡率。

Treatment of tracheobronchial foreign body in children at high altitude areas as Tibet

Abstract:ObjectiveTo analyze the characteristics of tracheobronchial foreign body in children in the Tibetan plateau region and investigate suitable diagnosis and treatment method for this disease at high altitude areas so as to improve therapeutic effect and safety and reduce mortality rate.MethodsClinical data of 25 children suffering from tracheobronchial foreign body were analyzed retrospectively. All the patients were treated in the General Hospital of the Tibet Military Region during Jan 2008 to May 2012. The analyzed data included the treatment methods and outcomes. The suitable diagnosis and treatment methods for tracheobronchial foreign body in children in the high altitude Tibetan plateau region were summarized.ResultsGeneral anesthesia plus surface division anesthesia were performed to all the 25 patients. Rigid bronchoscopy was applied to 12 cases and the foreign body was successfully removed in 10, 2 cases were transferred to low altitude hospitals and got successful removal. Direct laryngoscopy was performed in 3 cases, the foreign body was removed successfully in 2, and the failed case received rigid bronchoscopy and succeeded. Fiberbronchoscopy was performed in 4 cases. Of them, removal of foreign body succeeded in one and failed in 3 including 2 death cases. Tracheotomy was carried out in 4 cases with successful removal of the foreign body. 2 cases were transferred to Department of Cardiothoracic Surgery and got successful removal of the foreign body with thoracotomy.ConclusionFast and accurate diagnosis, proper choice of feasible treatment can effectively relieve the suffering of patients, reduce complications and mortality of tracheobronchial foreign body in children at high altitude areas.