750例急诊气道异物患儿的诊断思路及临床分析(1)
【摘要】 目的 分析兒童气道异物的病例特点， 总结其流行病学规律及诊断要点， 减少儿童气道异物的发生及误诊。方法 回顾性分析750例气道异物患儿的临床资料。结果 750例患者中， 1～3岁患儿占总发病数的78.8%；男女比为1.53∶1；城乡比为1∶1.98；大部分异物位于右侧支气管；在所有异物中， 坚果类占大多数；79.7%患儿在急诊滞留时间<24 h；83.6%有明确异物呛咳史；42.3%通过病史结合X线气道异物常规检查确诊， 50.7%通过肺部CT明确诊断， 7.1%需经纤支镜确诊， 肺部CT诊断灵敏度高于气道异物常规诊断， 差异具有统计学意义(P<0.05)；7 d内未得到有效治疗152例(20.3%)， 其中118例因家长就诊延迟， 34例在门诊以肺炎误诊。结论 儿童气道异物的发生具有明显的性别、年龄、城乡、季节分布特征， 以坚果类食物为主， 常有进食呛咳等诱因。当有明确异物呛咳史及异常体征时首选气道异物常规检查， 对于缺乏异物呛咳史的慢性咳嗽， 或有异物呛咳史但临床体征不典型时需行CT检查， 对于CT检查仍然不能明确诊断的可疑气道异物病例应进行纤支镜探查。
【关键词】 气道异物；儿童；急诊；影像学诊断
DOI：10.14163/j.cnki.11-5547/r.2017.17.018
Diagnosis thought and clinical analysis of 750 children with airway foreign bodies in emergency treatment LU Jia-ming， SONG Yong-ling， LI Pei-qing. Women and children’s Medical Center， Guangzhou 511000， China
【Abstract】 Objective To analyze medical characteristics of children with airway foreign bodies， to summarize epidemiological regularity and diagnosis key points， in order to reduce occurrence and misdiagnosis of children with airway foreign bodies. Methods A retrospective analysis was made on clinical data of 750 children patients with airway foreign bodies. Results Among the 750 patients， children aging 1～3 years old accounted for 78.8% in total morbidity. Male female ratio was 1.53∶1， and urban rural ratio was 1∶1.98. Most of foreign bodies were in right bronchia， and nut fruits were the major foreign body type. 79.7% of children patients had emergency stay time <24 h. 83.6% of children patients had clear history of foreign body bucking. There were 42.3% of diagnosed patients by medical history combined with conventional X-ray airway foreign bodies examination， 50.7% of diagnosed patients by lung CT， and 7.1% of diagnosis patients by bronchofiberscope. Lung CT showed higher sensitivity than conventional X-ray airway foreign bodies examination， and the difference had statistical significance (P<0.05). There were 152 cases without effective treatment within 7 d (20.3%)， including 118 delayed cases due to parent reasons and 34 misdiagnosed cases as pneumonia. Conclusion Airway foreign bodies in children contain obvious distribution characteristics of gender， age， urban and rural area， and season. Nut fruits are the main foreign body type， with feed bucking as inducement. Clear foreign body bucking history and abnormal vital sign require primary airway foreign bodies examination. CT is necessary for chronic cough without foreign body bucking history， or atypical clinical symptom with foreign body bucking history. Bronchofiberscope examination is necessary for suspected airway foreign bodies that cannot be diagnosed by CT examination., 百拇医药(卢嘉铭 宋永玲 李佩青)
【关键词】 气道异物；儿童；急诊；影像学诊断
DOI：10.14163/j.cnki.11-5547/r.2017.17.018
Diagnosis thought and clinical analysis of 750 children with airway foreign bodies in emergency treatment LU Jia-ming， SONG Yong-ling， LI Pei-qing. Women and children’s Medical Center， Guangzhou 511000， China
【Abstract】 Objective To analyze medical characteristics of children with airway foreign bodies， to summarize epidemiological regularity and diagnosis key points， in order to reduce occurrence and misdiagnosis of children with airway foreign bodies. Methods A retrospective analysis was made on clinical data of 750 children patients with airway foreign bodies. Results Among the 750 patients， children aging 1～3 years old accounted for 78.8% in total morbidity. Male female ratio was 1.53∶1， and urban rural ratio was 1∶1.98. Most of foreign bodies were in right bronchia， and nut fruits were the major foreign body type. 79.7% of children patients had emergency stay time <24 h. 83.6% of children patients had clear history of foreign body bucking. There were 42.3% of diagnosed patients by medical history combined with conventional X-ray airway foreign bodies examination， 50.7% of diagnosed patients by lung CT， and 7.1% of diagnosis patients by bronchofiberscope. Lung CT showed higher sensitivity than conventional X-ray airway foreign bodies examination， and the difference had statistical significance (P<0.05). There were 152 cases without effective treatment within 7 d (20.3%)， including 118 delayed cases due to parent reasons and 34 misdiagnosed cases as pneumonia. Conclusion Airway foreign bodies in children contain obvious distribution characteristics of gender， age， urban and rural area， and season. Nut fruits are the main foreign body type， with feed bucking as inducement. Clear foreign body bucking history and abnormal vital sign require primary airway foreign bodies examination. CT is necessary for chronic cough without foreign body bucking history， or atypical clinical symptom with foreign body bucking history. Bronchofiberscope examination is necessary for suspected airway foreign bodies that cannot be diagnosed by CT examination., 百拇医药(卢嘉铭 宋永玲 李佩青)