Fu T X, Wang X, Liu M L
Department of Geriatrics, Peking University First Hospital, Beijing 100034, China.
Department of Respiratory, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Apr 18;50(2):375-377.
57-year-old male was admitted to hospital for severe headache and seizure attacks on November 6th, 2016. After radiology and spinal fluid examination, he was diagnosed with viral encephalitis and treated with antiviral medicine, antibiotics and mannitol, but he was in sustained unconsciousness and weak in expectorating. The patient was given oxygen through artificial nasal after bedside tracheotomy. At 1:00 am on January 12th, 2016, there was a sudden drop in blood pressure, heart rate and oxygen saturation with left lung breath sounds slightly lower than the other side. The patient was connected to a ventilator with tidal volume of 300-500 mL and airway pressure of 16-24 cmHO (1 cmHO=0.098 kPa). In the meanwhile, the left side sponge of artificial nasal was found missing. Bedside chest X-ray showed no significant atelectasis. At that time the evidence of airway foreign body aspiration was not sufficient, so no urgent bronchoscopy was performed. At 9:00 am on January 14th, 2016, there was another sudden decline in oxygen saturation with diminished left lung breath sounds and decreased left thoracic activity. Since left atelectasis could not be ruled out, bedside bronchoscopy was performed. In the operation, two sponge-like objects were found at the left main bronchus and the opening of left upper lobe bronchial. Foreign body forceps were used to remove them. The foreign bodies were proved to be the left sponge of artificial nasal afterwards. Symptoms and signs caused by aspiration of foreign body in adults were widely various and depending on the nature of the foreign body, site, time and whether there was infection or not. Foreign body aspiration caused by artificial nasal sponge was rare in clinical practice. This case was a living reminder to perform bronchoscopy when foreign body aspiration was suspected. For the unconscious and elderly patient, whose history of foreign body aspiration usually could not be clearly provided, when atelectasis was suspected, bronchoscopy should be performed progressively, and more effective measures should be taken to prevent sponge of artificial nasal displacement.
2016年11月6日，一名57岁男性因严重头痛和癫痫发作入院。经影像学和脑脊液检查，诊断为病毒性脑炎，给予抗病毒药物、抗生素和甘露醇治疗，但患者持续昏迷，咳痰无力。床边气管切开术后经人工鼻给氧。2016年1月12日凌晨1点，患者血压、心率和血氧饱和度突然下降，左肺呼吸音略低于另一侧。患者连接呼吸机，潮气量为300 - 500 mL，气道压力为16 - 24 cmH₂O（1 cmH₂O = 0.098 kPa）。同时，发现人工鼻左侧海绵缺失。床边胸部X线显示无明显肺不张。当时气道异物吸入的证据不足，故未进行紧急支气管镜检查。2016年1月14日上午9点，血氧饱和度再次突然下降，左肺呼吸音减弱，左胸廓活动度降低。由于不能排除左肺不张，遂行床边支气管镜检查。术中在左主支气管及左上叶支气管开口处发现两块海绵样物，用异物钳取出。术后证实异物为人工鼻左侧海绵。成人异物吸入引起的症状和体征多种多样，取决于异物的性质、部位、时间以及是否存在感染等。人工鼻海绵引起的异物吸入在临床实践中较为罕见。该病例提醒我们，当怀疑有异物吸入时应进行支气管镜检查。对于意识不清的老年患者，往往无法明确提供异物吸入史，当怀疑有肺不张时，应及时进行支气管镜检查，并采取更有效的措施防止人工鼻海绵移位。
