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儿童气管支气管异物吸入的麻醉考量

The anaesthetic consideration of tracheobronchial foreign body aspiration in children.

作者信息

Kendigelen Pinar

机构信息

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.

出版信息

J Thorac Dis. 2016 Dec;8(12):3803-3807. doi: 10.21037/jtd.2016.12.69.

Abstract

Cases of tracheobronchial foreign body aspiration are frequently encountered emergency cases of childhood; and, delays in its recognition and treatment do result in serious morbidity and mortality. Diagnosis mainly relies on taking history which should indicate what the foreign body is, when it has been aspirated and where it is located. Belated consultation can cause misdiagnosis with the mixing of the symptoms and data with those of other pathologies common to childhood and further delays in the correct diagnosis. Bronchoscopy is required for the differential diagnosis of suspected tracheobronchial foreign body aspiration in order to eliminate other common pediatric respiratory concerns. Given the shared use of the airways by the surgeon and the anaesthesiologist, bronchoscopy is a challenging procedure requiring experienced teams with an efficient method of intercommunication, and also well planning of the anaesthesia and bronchoscopy ahead of the procedures. Despite the recent popularisation of the fiberoptic brochoscopes, the rigid bronchoscopy remains to be used commonly and is regarded to provide the gold standard technique. There have been reports in the literature on the uses of inhalation and/or intravenous (IV) anaesthesia and spontaneous or controlled ventilation methods without any demonstration of the superiority of one technique over the other. The most suitable methods of anaesthesia and ventilation would be those that reduce the risks of complications, morbidity and mortality; and, preventive measures should be taken with priority against childhood cases of tracheobronchial foreign body aspiration.

摘要

气管支气管异物吸入是儿童常见的急症;对其识别和治疗的延误确实会导致严重的发病率和死亡率。诊断主要依靠病史采集,病史应表明异物是什么、何时吸入以及位于何处。延迟会诊可能会导致误诊,症状和数据与儿童其他常见病症的症状和数据混淆,进而进一步延误正确诊断。对于疑似气管支气管异物吸入的鉴别诊断需要进行支气管镜检查,以排除其他常见的儿科呼吸系统问题。鉴于外科医生和麻醉医生共同使用气道,支气管镜检查是一项具有挑战性的操作,需要经验丰富的团队、高效的沟通方法,并且在操作前对麻醉和支气管镜检查进行精心规划。尽管近年来纤维支气管镜已普及,但硬支气管镜仍被普遍使用,并被视为提供金标准技术。文献中有关于吸入和/或静脉麻醉以及自主或控制通气方法使用的报道,但没有任何一种技术优于另一种技术的证明。最合适的麻醉和通气方法应该是那些降低并发症、发病率和死亡率风险的方法;并且,应优先采取预防措施以应对儿童气管支气管异物吸入病例。

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