儿童气管支气管异物延误诊断的原因及影响分析

目的探讨儿童气管支气管异物延误诊断的原因及影响,为进一步提高对该病的认识提供临床依据。方法选取2016年1月1日至2017年12月31日在西安市儿童医院呼吸一科因气管支气管异物住院的患儿342例,在患儿呛咳或出现症状后,≤7天确诊为早期诊断组(228例),>7天确诊则为延误诊断组(114例),对其临床资料进行回顾性分析。结果患儿发病年龄集中在≥1~<3岁(85.7%),男∶女=2∶1,植物性异物占绝大多数(90.4%),1、2月份气管支气管异物发病率较高,分别为10.2%,14.9%。与早期诊断组相比,延误诊断组患儿来自农村的比例及病程中发热的比例均明显升高(χ~2值分别为6.637、42.092,均P<0.05),院外接受抗生素或激素治疗比例、无并发症比例均显著增高(χ~2值分别为129.848、10.206,均P<0.01),住院时间明显延长(t=-4.470,P<0.01),家属提供呛咳史的比例明显减少(χ~2=43.589,P<0.01)。结论患儿家长未主动提供呛咳病史、医生的诊断意识不够、不恰当地使用抗生素或激素是造成延误诊断的主要原因,延误诊断可增加肺气肿、肺炎、肺不张等并发症发生,对反复呼吸道感染、慢性咳嗽、反复喘息的患儿应酌情考虑行支气管镜检查。

The analysis on cause and effect of delayed diagnosis of tracheobronchial foreign body in children

Objective To explore the cause and effect of delayed diagnosis of tracheobronchial foreign body in children,and to provide clinical basis to further improve the understanding of the disease.Methods 342 children with tracheobronchial foreign body admitted to the First Respiratory Department of Xi’an Children’s Hospital from January 1,2016 to December 31,2017 were selected,228 cases were diagnosed as the early diagnosis group within 7 days after coughing or symptom onset,and 114 cases were diagnosed as delayed diagnosis group more than 7 days after coughing or symptom onset,and their clinical data were analyzed retrospectively.Results The onset age in children patients was mainly concentrated in 1-3 years old(85.7%).The ratio of male∶female was 2∶1.Most of the foreign bodies were plant foreign body(90.4%).The incidence of tracheobronchial foreign body was relatively higher in January and February,which were 10.2%and 14.9%,respectively.Compared with the early diagnosis group,the proportion of children from rural areas and fever symptoms in the course of the disease were significantly higher(χ~2=6.637 and 42.092,respectively,both P<0.05)in delayed diagnosis group,the proportion of antibiotics and glucocorticoids treatment before hospitalization and the proportion of complications were significantly higher(χ~2=129.848 and 10.026,both P<0.01)in delayed diagnosis group,the length of hospital stay was significantly longer(t=-4.470,P<0.01)in delayed diagnosis group,and the proportion of choking histories provided by family members was significantly lower in the delayed diagnosis group(χ~2=43.589,P<0.01).Conclusion The main causes of delayed diagnosis are the failure to provide history of coughing actively by parents,the lack of awareness of diagnosis by doctors,and inappropriate use of antibiotics or glucocorticoids.Delayed diagnosis of the diseases could increase the occurrence of complications such as emphysema,pneumonia,and atelectasis.Children with recurrent respiratory tract infections,chronic cough and recurrent wheezing should be considered for the examination of bronchoscopy as appropriate。