319例气管支气管异物的临床诊治分析

Clinical analysis of 319 cases of tracheobronchial foreign body

摘要:

目的 探讨气管支气管异物的临床特点，分析多学科团队协作（MDT）、多排螺旋CT （MDCT）及后处理技术、麻醉方式选择、硬质气管镜手术、并发症治疗等在快速、有效诊治气管支气管异物中的应用，总结气管支气管异物诊治过程中的注意事项。方法 回顾性分析2016年1月1日—2019年12月31日经硬质气管镜确诊的319例气管、支气管异物患者的临床特点、术前诊断、手术情况及并发症、异物诱因及部位、异物种类。结果 本组319例气管支气管异物患者均不同程度应用MDT模式，317例异物由硬支气管镜成功取出，1例异物为别针的患儿转胸外科开胸取出，1例异物为枣核的患儿由基层医院转至我院途中出现呼吸心跳停止，在胸外持续按压气囊辅助呼吸的情况下取出异物，患儿呈现植物状态，后家属放弃治疗。结论 MDT、MDCT、麻醉方式选择等在呼吸道异物的诊治中发挥重要作用。经确诊或高度怀疑的患者，应尽快行支气管镜检查，全身麻醉应达到一定的深度，是否维持自主呼吸与异物大小及所在部位有关，手术操作应轻柔准确，并注意观察患者全身状况，是减少并发症的关键。

关键词:气管支气管异物;多学科团队协作;硬性支气管镜;麻醉;多排螺旋CT

Abstract:

Objective To explore the clinical characteristics of tracheobronchial foreign bodies and analyze the application of multidisciplinary team work (MDT), multislice spiral computed tomography (MDCT), post-processing technology, anesthesia mode selection, rigid tracheoscopy and complication treatment as well as the precautions in the diagnosis and treatment of tracheobronchial foreign bodies. Methods Clinical data of 319 patients suffering from tracheal and bronchial foreign bodies diagnosed by rigid bronchoscopy from Jan 1, 2016 to Dec 31, 2019 were analyzed retrospectively. The analyzed data included clinical characteristics, preoperative diagnosis, surgical conditions and complications, precipitating factors and locations as well as the types of foreign bodies. Results In this study, MDT mode was to varying degrees applied to all the 319 patients. Of them, foreign bodies were successfully removed by hard bronchoscope in 317 and by thoracotomy in one pediatric case. The family of one pediatric patient gave up treatment due to persistent vegetative state after extraction of date pit with continuous external chest compression and balloon assisted breathing under the condition of out-of-hospital cardiopulmonary arrest. Conclusion MDT, MDCT and the choice of anesthesia mode play important roles in the diagnosis and treatment of foreign body in respiratory tract. Bronchoscopy should be performed as soon as possible for the confirmed or highly suspected patients. General anesthesia should reach a sufficient depth. Whether or not to sustain spontaneous ventilation is related to the size and location of the foreign body. Meticulous and accurate surgical operation, close observation of the patient's general condition are essential to reduce complications.

Key words:Tracheobronchial foreign body;Multidisciplinary team work;Rigid bronchoscope;Anesthesia;Multislice spiral computed tomography