以影像監視之硬式通氣式支氣管鏡術摘除嬰幼兒氣道異物

Video-assisted Rigid Ventilation Bronchoscopy for the Removal of Airway Foreign Bodies in Children

李振川(Jehn-Chuan Lee) ； 楊政謙(Cheng-Chien Yung) ； 李國森(Kuo-Sheng Lee) ； 何冠旻(Guan-Min Ho) ； 張克昌(Ke-Chang Chang)

《台灣耳鼻喉頭頸外科雜誌》 38卷1期 (2003/02) Pp. 16-20

https://doi.org/10.6286/2003.38.1.16

摘要

背景：嬰幼兒呼吸道異物是耳鼻喉科重要的急症，本篇的目的是要提出兼顧診斷與治療的方法。
方法：本科收集自1995年1月至2001年12月，以影像系統輔助硬式通氣式支氣管鏡術治療嬰幼兒氣道異物的病例。回溯分析這些病例的基本資料、臨床相關病徵、吸氣及呼吸相的胸部X光檢查、及治療結果。
結果：本科7年間，共計90例嬰幼兒因懷疑呼吸道異物，而接受影像系統輔助硬式通氣式支氣管鏡術的治療，其中發現有氣道異物的病例，共80例，臨床診斷率達89%。其中男性56例，女性24例，平均年齡24個月。臨床相關病徵，以嗆咳後呼吸困難最多，佔88%(70/80)，其次為持續咳嗽(69%)、不對稱呼吸聲(50%)。胸部X光的表現，以肺氣腫最多，佔60%(48/80)。80例氣道異物發生位置以右主支氣管最多，佔36%(29/80)，其次為氣管或隆凸(20%)，左側主支氣管(20%)，喉部(10%)，左下肺葉(10%)，右支氣管中間部(8%)，其中8例有多處氣道異物。異物種類以花生最多，佔58%(46/80)。術後10例因氣道水腫，須插管維持呼吸，因此轉住加護病房，其中2例因是氣管異物延誤就醫而死亡，死亡率為2%(2/90)。
結論：嬰幼兒氣道異物的早期診斷必須仰賴詳細的病史、臨床病徵、理學檢查，而影像系統輔助的硬式通氣式支氣管鏡術，是兼具有診斷與治療價值的安全方法。

關鍵字

氣道異物 ； 影像系統輔助硬式通氣式支氣管鏡術 ； 嬰幼兒

並列摘要

BACKGROUND: Airway foreign bodies in children are an emergency for ENT doctors. The purpose of this study was to share our past experience in the diagnosis and treatment.
METHOD: Our department collected cases in the period from January, 1995 to December, 2001, in which video-assisted rigid ventilation bronchoscopy was used for the removal of airway foreign bodies in children. These cases were retrospectively analyzed, assessing basic data, clinical manifestations, inspiratory and expiratory chest x-ray and the clinical course after treatment.
RESULTS: During seven consecutive years, a total of 90 patients, with suspected airway foreign bodies, underwent video-assisted rigid ventilation bronchoscopy for the purpose of foreign bodies removal. In 80 cases airway foreign bodies were found (56 male and 24 female, mean age 24 months). Dyspnea was the most frequently observed symptom after initial chocking, representing 88% (70/80) of all symptoms, followed by persistent cough (69%), and asymmetric breathing sound (50%), respectively. Emphysema of lung accounted for 60% (48/80) of all pathological changes on x-ray films and was also the most commonly noted finding. Out of 80 cases, eight were found to have foreign bodies in multiple locations. Airway foreign bodies were mainly found in the right main bronchus (36%), followed by the trachea or carina (20%), left main bronchus (20%), larynx (10%), left lower lobe (10%), and right intermediate bronchus (8%). Peanuts were the most commonly found foreign body, accounting for 58% (46/80). Ten cases were transferred to the intensive care unit for further management after surgery, and two of these patients ultimately died, largely due to delayed hospitalization. The mortality rate was 2% (2/90).
CONCLUSIONS: Early and accurate diagnosis of airway foreign bodies in children depends on a thorough medical history, physical examinations and identification of clinical signs. Video-assisted rigid ventilation bronchoscopy, is a safe procedure that can be utilized for both the diagnosis and removal of foreign bodies.

並列關鍵字

airway foreign body ； video-assisted rigid ventilation bronchoscopy ； children