Farrell Patrick T
Department of Anaesthesia, John Hunter Hospital, Newcastle, Australia.
Paediatr Anaesth. 2004 Jan;14(1):84-9. doi: 10.1046/j.1460-9592.2003.01194.x.
Foreign body aspiration is a leading cause of death in children 1-3 years old, although mortality is low for children who reach the hospital. Presenting symptoms of an inhaled foreign body depends on time since aspiration. Immediately after inhalation the child starts to cough, wheeze, or have laboured breathing. If the early signs are missed, the child usually presents with fever and other signs and symptoms of chest infection. A plain chest X-ray has relatively low sensitivity and specificity for inhaled foreign body. The gold standard for diagnosis and management of this condition is rigid open tube bronchoscopy under general anaesthesia. For late presentations, time should be taken to fast the child and complete a thorough evaluation before bronchoscopy. The procedure should be performed in a well-equipped room with at least two anaesthesiologists, one with paediatric experience, in attendance. Most experienced anaesthesiologists prefer inhalational rather than intravenous induction of anaesthesia and a ventilating bronchoscope rather than intubation. Equally good results have been reported with spontaneous ventilation or positive pressure ventilation; jet ventilation is not advocated for foreign body removal in children.
异物吸入是1至3岁儿童死亡的主要原因，不过对于送至医院的儿童而言，死亡率较低。吸入异物后的症状表现取决于自吸入后经过的时间。吸入异物后，患儿即刻开始咳嗽、喘息或呼吸费力。如果早期症状被漏诊，患儿通常会出现发热及胸部感染的其他体征和症状。胸部X线平片对吸入异物的敏感性和特异性相对较低。诊断和处理这种情况的金标准是在全身麻醉下进行硬质开放管支气管镜检查。对于就诊较晚的患儿，在进行支气管镜检查前，应让患儿禁食并完成全面评估。该操作应在设备完善的房间内进行，至少有两名麻醉医生在场，其中一名要有儿科麻醉经验。大多数经验丰富的麻醉医生更倾向于采用吸入麻醉诱导而非静脉麻醉诱导，以及使用通气支气管镜而非插管。据报道，自主通气或正压通气也能取得同样好的效果；不主张在儿童异物取出术中使用喷射通气。
