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[动态肺密度测定法在儿童下呼吸道X线无对比剂异物诊断中的应用]

[Dynamic pulmonary densitography in the diagnosis of radiographically non-contrasting foreign bodies in the lower respiratory tract in children].

作者信息

Rous J, Simecek C, Cermák Z

机构信息

Katedra otorinolaryngologie a oftalmologie lékarské fakulty UK, Pizen.

出版信息

Cesk Otolaryngol. 1990 Nov;39(6):350-7.

PMID:2292109
Abstract

Densitographic examination of the regional pulmonary ventilation is a non-pretentious and non-invasive method which can be used even in very young children, which when aspiration of a non-contrasting foreign body is suspected can confirm by revealing localized bronchial obstruction the presence of a foreign body and determine its localization in the tracheobronchial tree. By repeated records of adequate ventilation at rest in all pulmonary fields it is possible with a minimal radiation load to rule out the suspicion and the child need not be subjected to an endoscopic examination. In five children aged 19 months to 13 years the usefulness of this procedure for the diagnosis of aspiration of a non-contrasting foreign body was proved, as the physical and skiagraphic finding was not convincing, there was discrepancy of anamnestic data and results of repeated skiagraphic examinations, negative auscultation and negative X-ray examination after an anamnestically obvious cse of aspiration, it ws used, for a more accurate localization of the aspired object, and to confirm localized obstruction of pulmonary ventilation in a chronic foreign body of plant origin in the airways. Foreign bodies of plant origin, most frequently aspired by children, are dangerous because they are fragile, swell and exert toxic action on the bronchial mucosa and there is also the danger of rapid development of serious bronchopulmonary complications. Therefore early diagnosis of aspiration is essential in these frequently obscure situations. When the direct skiagraphic signs of their presence in the lower airways are lacking dynamic pulmonary densitography contributes greatly to the diagnosis.

摘要

区域肺通气的密度测定检查是一种简便且无创的方法,甚至可用于非常年幼的儿童。当怀疑有非造影剂异物吸入时,该检查可通过显示局部支气管阻塞来确认异物的存在,并确定其在气管支气管树中的位置。通过对所有肺野静息时充分通气的重复记录,以最小的辐射负荷排除怀疑,从而无需对儿童进行内镜检查。在5名年龄在19个月至13岁的儿童中,证明了该程序对诊断非造影剂异物吸入的有用性。由于体格检查和X线检查结果不具说服力,既往史数据与重复X线检查结果存在差异,在既往史明确提示有吸入异物的情况下听诊阴性且X线检查阴性,故使用该检查来更准确地定位吸入物体,并确认气道中植物源性慢性异物引起的局部肺通气阻塞。植物源性异物是儿童最常吸入的异物,因其易碎、会膨胀并对支气管黏膜产生毒性作用而具有危险性,且还存在严重支气管肺并发症迅速发展的风险。因此,在这些常常模糊不清的情况下,早期诊断吸入异物至关重要。当下呼吸道缺乏其存在的直接X线征象时,动态肺密度测定对诊断有很大帮助。

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