異物誤食：患者、異物的特性及成人與兒童間的比較

Aerodigestive Foreign Bodies: Characteristics of Patients and Foreign Bodies, and Comparison between Adults and Children

賴麗芬(Li-Fen Lai) ； 黃英傑(Ying-Chieh Huang) ； 陳啟益(Chi-I Chen)

《南臺灣醫學雜誌》 11卷1期 (2015/06) Pp. 9-23

https://doi.org/10.6726/MJST.201506_11(1).0002

摘要

目的：胃腸呼吸道異物常見，患者咳嗽、嘔吐、局部不適、吞嚥呼吸困難，未及時處置嚴重會窒息。日後可有併發症、甚至死亡。方法：使用描述性統計，分析2012年誤食異物的急診患者。以卡方檢定和蒙特卡羅估計比較兒童與成人的差異。結果：所收納137位兒童與503位成人，週日及傍晚至午夜時段最常見。患者多於六小時內就醫，2.7%超過三天。患者88.4%進食中發生。吞嚥困難者55.9%、疼痛39.2%。近半數患者接受影像檢查。魚刺最常見，異物最常在咽、食道與喉。異物45.9%目視取出,44.1%自行排出，10.0%內視鏡移除。兒童與成人比較，就醫時間與影像檢查比率無差異。兒童較常誤食（p ＜ 0.001），咳嗽（p=0.001）、哮喘（p=0.046）。異物種類不同（p ＜ 0.001）：成人多魚刺、雞骨、假牙；兒童多非食物、硬幣、食物碎片。處置有差別（p ＜ 0.001）：成人較多直接或內視鏡移除，兒童較多自行排出。患者多處置後出院，兒童住院與轉院比率較高。結論：誤食異物帶來痛苦與昂貴醫療開銷。我們應落實餐桌禮儀，重視照顧者教育，規範安全玩具、飾品、藥品及牙科治療。

關鍵字

異物 ； 嗆噎 ； 吞食 ； 吸入

並列摘要

Objective: Aerodigestive foreign bodies (FB) are common. Patients cough, vomit, feel local discomfort, dysphagia, and dyspnea. Without treatment, suffocated patients may die. Other patients may suffer from late complications, and even death. Methods: We used descriptive statistics to analyze patients visiting our Emergency Department (ED) for aerodigestive FB in 2012. Comparison between children an adults was performed with Chi-square test and Monte Carlo estimation. Results: There were 137 children and 503 adults enrolled. Sunday and evening to midnight were the peaks of visiting. Most of the patients visited the ED within 6 hours of event but 2.7% delayed over 3 days. Most (88.4%) cases choked during ingestion. Near half patients received imaging exam, fishbone is the most common FB. Pharynx, esophagus, and larynx were the most common sites of FB impaction. FB were removed directly (45.9%), past spontaneously (44.1%), removed by endoscopy (10.0%). In comparison with adults, children did not have quicker trip to the doctor or received more imaging examination. Children had higher percentage of mis-swallowing (p＜0.001), cough (p=0.001), and stridor (p=0.046). FB were different (p ＜ 0.001) , with more fishbone, chicken bones, teeth in adults, and more non-food objects, coins, food chips in children. More adults received direct or endoscopic removal of FB, but more spontaneous pass in children (p＜0.001). Most patients were discharged from ED; however, children had higher percentage of hospitalization and transfer. Conclusions: Aerodigestive FB are suffering and costly. We have to promote table manners, educate the carers, regulate and provide safe toys, accessories, medicine, and dental care.

並列關鍵字

foreign bodies ； choking ； ingestion ； aspiration