Mahajan Jai Kumar, Rathod Kirti K, Bawa Monika, Rao Katragadda L N
Department of Pediatric Surgery, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Bronchology Interv Pulmonol. 2011 Jul;18(3):223-8. doi: 10.1097/LBR.0b013e31822386a4.
Foreign body aspirations (FBA) in the tracheobronchial tree must be suspected in children who present with a witnessed history of choking or respiratory distress of sudden onset and asymmetric breath sounds, even in the absence of pathognomonic radiographic findings. This study reviews our experience with a variety of FBA and outlines the salient differences in the literature.
One hundred eighty-four consecutive children with a history suggestive of FBA undergoing bronchoscopy over a period of 10 years were reviewed. In all of the cases, rigid bronchoscopy was performed under general anesthesia using a Storz ventilating bronchoscope with the aid of optical forceps.
In 166 (90.21%) patients, a foreign body (FB) was discovered, whereas in 18 (9.78%) children, no FB could be found. The highest incidence of FBA (126/166, 75.9%) was found in the age group between 1 and 5 years. FBA of organic origin were more common (77.77%) in the younger patients (<3 y) as compared with the older patients (12.23%, >3 y) (P<0.0001). The radiographs were suggestive in 90% of the children >5 years of age (P<0.0063). Seven patients had a delay in the diagnosis and were being treated for various medical ailments. The incidence of FBA was almost double (64.83%) during the winter months as compared with rest of the year (34.17%). Pen cap aspirations were seen in 7 patients, and 6 of them could be extracted successfully with bronchoscopy. Two patients died.
Bronchoscopy can be a life-saving procedure and is safe even when no FB is found. The parameters of the history of witnessed choking, respiratory distress of sudden onset, and the asymmetric breath sounds are used in the decision making to perform a bronchoscopy. Radiographs are less helpful in younger patients. Nonorganic FBA is more common in older children. There may be seasonal variations and more attention should be given to small children during the times of high incidence.
对于有窒息目击史或突发呼吸窘迫且呼吸音不对称的儿童，即使没有特征性的影像学表现，也必须怀疑气管支气管树内有异物吸入（FBA）。本研究回顾了我们处理各种FBA的经验，并概述了文献中的显著差异。
回顾了10年间连续184例有FBA病史并接受支气管镜检查的儿童。所有病例均在全身麻醉下使用史托斯通气支气管镜并借助光学镊子进行硬质支气管镜检查。
166例（90.21%）患者发现异物（FB），18例（9.78%）儿童未发现FB。FBA发病率最高（126/166，75.9%）的年龄组为1至5岁。与年长患者（>3岁，12.23%）相比，年龄较小患者（<3岁）中有机源性FBA更为常见（77.77%）（P<0.0001）。5岁以上儿童中90%的X线片有提示意义（P<0.0063）。7例患者诊断延迟，一直在接受各种疾病的治疗。与一年中的其他时间（34.17%）相比，冬季FBA发病率几乎翻倍（64.83%）。7例患者有笔帽吸入，其中6例可通过支气管镜成功取出。2例患者死亡。
支气管镜检查可能是一种挽救生命的操作，即使未发现FB也是安全的。目击窒息史、突发呼吸窘迫和呼吸音不对称等病史参数用于决定是否进行支气管镜检查。X线片对年幼患者帮助较小。非有机性FBA在大龄儿童中更常见。可能存在季节性变化，在高发期应更加关注幼儿。
