Tariq P
Department of Pediatrics, Rawalpindi Medical College, Rawalpindi.
J Pak Med Assoc. 1999 Feb;49(2):33-6.
Cough and respiratory distress due to foreign body inhalation in children is a common problem in our society. This study was planned to identify the criteria for early diagnosis and management in suspected cases of foreign body inhalation.
The study was carried out on indoor patients of Paediatrics Department, Rawalpindi General Hospital (RGH) affiliated with Rawalpindi Medical College (RMC), from January, 1995 to December, 1996. Paediatrics Department has 50-bedded general paediatrics ward, 20-bedded neonatal unit (NNU) and 150-200 daily attendance of outpatient department (OPD). It offers primary to tertiary level care to its patients from whole of Rawalpindi Division.
This prospective study encompasses profile and immediate outcome of 20 suspected cases of foreign body inhalation. Selection of study subjects and subjection to bronchoscopy was based on symptomatology, clinical and radiological findings and response to treatment. The data with outcome was recorded on a proforma.
In 18 cases foreign body was removed successfully by rigid bronchoscope with immediate relief of symptoms and normal chest roentgenograms. Most susceptable age for foreign body inhalation was 1-3 years (n = 14) and male children were at higher risk than females (13 vs 7). Valuable clinical features were sudden onset with respiratory distress, cough, choking, localized poor air entry, crepitations or rhonchi in descending order of frequency. Most common finding in chest roentgenogram was consolidation-collapse and/or emphysema in 50% cases. 30% cases (n = 6) with persistent respiratory tract infection inspite of adequate treatment of recurrent episodes of respiratory distress with wheeze turned out as foreign body inhalation and therefore, such cases need re-evaluation. Betelnut was the most common foreign body removed (n = 7) followed by peanut (n = 6). Most frequent site involved was right main bronchus (n = 7) followed by left main bronchus (n = 5).
Public awareness through mass media needs attention to prevent foreign body inhalation. High index of clinical suspicion is mandatory for early diagnosis and management to prevent fatal outcome and long term morbidity.
儿童因异物吸入导致咳嗽和呼吸窘迫是我们社会中常见的问题。本研究旨在确定疑似异物吸入病例的早期诊断和管理标准。
该研究于1995年1月至1996年12月在拉瓦尔品第医学院附属拉瓦尔品第综合医院（RGH）儿科的住院患者中进行。儿科有一个50张床位的普通儿科病房、一个20张床位的新生儿病房（NNU）以及门诊部门（OPD）每天150 - 200人次的就诊量。它为来自拉瓦尔品第整个分区的患者提供从初级到三级的医疗服务。
这项前瞻性研究涵盖了20例疑似异物吸入病例的概况和即时结果。研究对象的选择以及进行支气管镜检查是基于症状学、临床和放射学检查结果以及对治疗的反应。带有结果的数据记录在一份表格上。
18例患者通过硬支气管镜成功取出异物，症状立即缓解，胸部X线片恢复正常。异物吸入最易感年龄为1 - 3岁（n = 14），男性儿童比女性儿童风险更高（13例对7例）。有价值的临床特征依次为突然发作伴呼吸窘迫、咳嗽、窒息、局部呼吸音减弱、捻发音或干啰音，出现频率递减。胸部X线片最常见的表现是50%的病例出现实变 - 肺不张和/或肺气肿。30%的病例（n = 6）尽管对反复出现的伴有喘息的呼吸窘迫进行了充分治疗，但仍持续发生呼吸道感染，结果证明是异物吸入，因此，此类病例需要重新评估。取出的异物中最常见的是槟榔（n = 7），其次是花生（n = 6）。最常受累的部位是右主支气管（n = 7），其次是左主支气管（n = 5）。
需要通过大众媒体提高公众意识以预防异物吸入。对于早期诊断和管理，保持高度的临床怀疑意识对于预防致命后果和长期发病至关重要。
