小兒氣道異物二十二年之經驗

Foreign Bodies Aspiration in Children Twenty-Two Years Experience in Changhua Christian Hospital

楊端青(Tuan-Ching Yuang) ； 林清淵(Ching-Yuang Lin) ； 曹龍彥(Lon-Yen Tsao) ； 邱漢堯(Han-Yao Chiu)

《中華民國兒童胸腔醫學會雜誌》 6卷1期 (2009/10) Pp. 24-31

https://doi.org/10.6322/JPRD.200910_6(1).0004

摘要

目的：探討小兒氣道異物發生之年齡層、症狀、影像學異常、異物種類、位置和併發症。
方法：採個案研究法，資料收集由ICD-9碼去調閱在1985年元月至2007年六月有氣道異物診斷的病例作為研究。
結果：本研究顯示總人數108人，其中男生66人(61.1%)，女生42人(38.9%)，男生個案數為女生的1.6倍。平均年齡為2.1歲。其中70.4%發生在一至三歲之兒童。臨床症狀以咳嗽為主，佔了將近八成，其次是呼吸困難。而突然發生之喘鳴則佔了約三成左右。在身體檢查方面，約有六成的病例有明顯的單側呼吸音減弱，伴隨著呼氣或吸氣喘鳴。術前的胸部X光片檢查，有將近六成的病例有肺氣腫情形，而將近三成(31.4%)的胸部X光片表現是正常的，肺部塌陷則只有7例(6.5%)。氣道異物以有機物佔了九成以上，花生佔總病例數57.4%。氣道異物的位置以右側居多，佔44.4%；次之為左側(40.7%)及氣管(13%)。從症狀或是病史開始到診斷時間，85%是在兩天以內發現。住院天數由一天到十六天，平均住院天數為4.1天。所有病例皆在全身麻醉下接受硬式支氣管鏡手術異物檢查，並隨後成功取出異物。手術後有共有九例有肺炎的併發症，但全部病例最後均治癒出院，沒有致死病例。
結論：避免幼兒接觸花生或是細微物品是預防氣道吸入的方法。若一至三歲小孩出現突然咳嗽、喘鳴等症狀，需強烈懷疑是否為氣道異物。詳實的病史問診非常重要，加上身體檢查，以及胸部X光片，應能夠早期診斷，並及時以硬式支氣管鏡手術取出，以期減少併發症的產生。

關鍵字

氣道 ； 異物 ； 肺氣腫 ； 支氣管鏡

並列摘要

Objective: To evaluate retrospectively the relationship of aspiration of children in the aspects of age, symtoms, imaging abnormalities, foreign body type and location and complications.
Method: Data collection was accessed by ICD-9 codes which were relative to tracheobronchial foreign body from 1985 to June 2007. Totally one hundred and eight children who have received bronchoscope and removed foreign bodies successfully were enrolled in this study.
Results: This study showed that boys accounted for 66 (61.1%), and girls accounted for 42 (38.9%) in the total number of 108 children who have received bronchoscope and removed foreign bodies successfully. The incidence of boys was about 1.6 times to the girls. The average age was 2.1 years old. Seventy four percent of the children were under the age of 3 years old. Cough was the main symtom accounting for nearly eightly percent, followed by short of breath. The sudden onset of stridor accounts aobut thirty percent. About sixty percent children were noted to have obviously decreased breathing sound in the affected lung field, accompanying with inspiratory or expiratory wheezing. There were fifth six point five percent children showed emphysema in the pre-operation chest X-ray examination. However, nothing specific radiographically was noted in the almost thirty percent children. Only four children have atelectasis. The organic foreign body accounts for ninety percent of aspiration, and most were peanuts. Right bronchus was main location where aspiration happened, while left one has similar incidence (44% vs 40%). The duration from beginning to diagnosis was under 48 hours in eighty five percent children. Mean hospitalization day was 4.1 days. All cases were underwent foreign body removing by bronchoscope with general anesthesia. 9 cases have complications (pneumonia), but no mortality in this study.
Conclusions: To avoid children from touching peanuts or fine objects is the only way to prevent from aspiration. If children under three years old have the symptom as cough or stridor suddenly, foreign body aspiration was highly suspected. Informative hiostory-taking with correlation of clinical symtom and radiography is the most important to meet the diagnosis of tracheobronchial foreign body aspiration and thus to decrease the mortality and morbidity.

並列關鍵字

trachea ； bronchus ； foreign body ； emphysema ； bronchoscope