Rouillon I, Charrier J B, Devictor D, Portier F, Lebret I Kerurien, Attal P, Le Pajolec C, Bobin S
Département d'otorhinolaryngologie et de chirurgie cervico-faciale, Hôpital Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270 Kremlin-Bicêtre, France.
Int J Pediatr Otorhinolaryngol. 2006 Nov;70(11):1949-55. doi: 10.1016/j.ijporl.2006.07.022. Epub 2006 Sep 6.
The authors describe 28 pediatric cases of foreign body inhalation requiring treatment in intensive care units between 1987 and 1999. The purpose of this study was: (1) to analyze the circumstances, diagnostic difficulties and initial treatment of serious foreign bodies and (2) to compare our series with other literature descriptions and define principles for optimal prevention and initial treatment.
Twenty-one children presented a penetration syndrome, which was responsible in 13 cases for asphyxia with cardiorespiratory arrest. All these children died, regardless of the initial treatment. Seven children were hospitalized for apparent asthmatic symptoms that did not respond to traditional treatment.
The inefficiency of external extraction methods like the Heimlich maneuver and the mean delay between clinical signs and initial treatment lead us to propose a new strategy for the emergency treatment of foreign bodies with asphyxia.
We recommend that emergency teams promote the use of a laryngoscope and Magill forceps. Flexible endoscopy is still recommended as the appropriate diagnostic tool to eliminate doubt in the case of a first severe asthma attack.
作者描述了1987年至1999年间28例需要在重症监护病房接受治疗的小儿异物吸入病例。本研究的目的是：（1）分析严重异物吸入的情况、诊断困难及初始治疗；（2）将我们的病例系列与其他文献描述进行比较，并确定最佳预防和初始治疗原则。
21名儿童出现穿透综合征，其中13例导致窒息伴心肺骤停。所有这些儿童均死亡，无论初始治疗情况如何。7名儿童因明显的哮喘症状住院，对传统治疗无反应。
海姆立克急救法等外部取出方法无效，以及临床症状与初始治疗之间的平均延迟，促使我们提出一种针对窒息性异物的紧急治疗新策略。
我们建议急救团队推广使用喉镜和麦吉尔钳。对于首次严重哮喘发作的病例，仍建议使用可弯曲内镜作为合适的诊断工具以消除疑虑。
