儿童气管、支气管异物各临床特征的诊断价值研究

目的]通过分析探讨儿童气管、支气管异物的临床特征,评估各项临床特征参数对儿童气管、支气管异物的诊断价值.方法]分析2012年9月至2016年9月于本院就诊的152例疑似气管、支气管异物患儿的异物吸入史,临床表现以及影像学检查资料.结果]以支气管镜发现异物为金标准,异物吸入史、吸气性呼吸困难、两侧呼吸音不对称或一侧呼吸音消失、X线胸片、肺部CT扫描阳性者与其阴性相应特征者比较,异物存留率高,差异有显著性(均P<0.05);而刺激性咳嗽、发热以及肺部啰音阳性者则无统计学意义(均P>0.05).异物吸入史、吸气性呼吸困难、两侧双侧呼吸音不对称或者一侧呼吸音消失、X线胸片、肺部CT扫描的灵敏度、阳性预测值、诊断符合率均比较高,但是特异度均不高.异物吸入史、肺部CT扫描与硬质支气管镜检比较,有较高的吻合度.结论]吸气性呼吸困难、两侧呼吸音不对称或一侧呼吸音消失、X线胸片对于小儿气管、支气管异物的诊断有一定的参考价值,异物吸入史和肺部CT扫描有较高的诊断价值.

Analysis of Sensitivity and Specificity of Clinical Features of Tracheobronchial Foreign Body Diagnosis in Children

Objective]To investigate the clinical characteristics of tracheobronchial foreign bodies in children for their diagnostic value in sensitivity and specificity.Methods]From September 2012 to September 2016,a total of 152 pediatric patients with suspected tracheobronchial foreign bodies were included in this study.The history of foreign body aspiration,clinical manifestation,chest X-ray examination and CT scanningwere analyzed.Results]Tracheobronchial foreign body diagnosis was confirmed by bronchoscopy.Judged by this standard,patients with positive foreign body aspiration history,inspiratory dyspnea,diminished breath sounds on one side of the chest or asymmetric breath sounds onboth sides of the chest,X-ray and CT scan findings in the chest had a higher rate of foreign bodies present;the difference was statistically significant (P<0.05).However,differences in rates of irritating cough,fever,and lung rale were not statistically significant (P>0.05).History of foreign body aspiration,inspiratory dyspnea,diminished breath sounds on one side of the chest or asymmetric breath sounds on two sides of the chest,chest X-ray findings,and CT scan showed a high sensitivity and positive predictive value that coincided with tracheobronchial foreign body diagnosis,but the specificity was not high.Foreign body aspiration history and chest CT scan had a high consistency with rigid bronchoscopy.Conclusion]Inspiratory dyspnea,diminished breath sounds on one side or asymmetric breath sounds on two sides of the chest,and chest X-ray findings have some reference value for tracheobronchial foreign body diagnosis.The history of foreign body aspiration and chest CT scan can provide higher diagnostic value with more accuracy.