Tan H K, Brown K, McGill T, Kenna M A, Lund D P, Healy G B
Department of Otolaryngology and Communication Disorders, Children's Hospital, Medical Center, Boston, MA 02115, USA.
Int J Pediatr Otorhinolaryngol. 2000 Dec 1;56(2):91-9. doi: 10.1016/s0165-5876(00)00391-8.
A retrospective chart review of children who had airway foreign body removed via direct laryngoscopy and bronchoscopy (DLB) from 1987-1997 was conducted in Children's Hospital, Boston. Patient characteristics noted included age, sex, and clinical presentation. Pre-operative radiographic findings, reason for delay in evaluation, DLB findings, length of procedure, reason for repeat DLB, and types of foreign body etc. were recorded. Serious complications from aspirated foreign bodies such as severe airway obstruction and death tend to occur in infants and younger children because of their small airway size. A history compatible with foreign body aspiration dictates diagnostic endoscopy with or without radiologic confirmation. Chest and airway radiographs supplemented by fluoroscopy can increase the ratio of correct and early diagnosis. Fluoroscopy should be universally accepted as an initial diagnostic technique in airway foreign body evaluation. Fluoroscopy is not a worthwhile investigation if a preceeding chest radiograph suggests the presence of a foreign body. Long-standing airway foreign bodies are associated with considerable morbidity, and early diagnosis remains the key to successful and uncomplicated management of foreign body aspiration. Education aimed at increasing diagnostic acumen of the physicians and heightening of public awareness are the most important steps needed to reduce the morbidity and mortality. Parents should be instructed to abstain from feeding nuts and seeds to young children and to keep small, potentially ingestible objects out of their reach.
对1987年至1997年间在波士顿儿童医院通过直接喉镜和支气管镜检查（DLB）取出气道异物的儿童进行了回顾性病历审查。记录的患者特征包括年龄、性别和临床表现。记录术前影像学检查结果、评估延迟的原因、DLB检查结果、手术时间、重复DLB的原因以及异物类型等。由于婴儿和年幼儿童气道较小，吸入异物导致的严重并发症如严重气道阻塞和死亡往往发生在他们身上。与异物吸入相符的病史决定了无论有无影像学确认都应进行诊断性内镜检查。胸部和气道X线片辅以透视检查可提高正确和早期诊断的比例。透视检查应被普遍接受为气道异物评估的初始诊断技术。如果之前的胸部X线片提示存在异物，透视检查就不是一项有价值的检查。长期存在的气道异物会导致相当高的发病率，早期诊断仍然是成功且无并发症地处理异物吸入的关键。旨在提高医生诊断敏锐度和增强公众意识的教育是降低发病率和死亡率所需的最重要步骤。应指导家长不要给幼儿喂食坚果和种子，并将小的、可能被误食的物品放在他们够不到的地方。
