儿童气管支气管异物吸入的临床分析：重点关注外在和内在因素。
Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Health Management Center, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China.
出版信息
BMC Surg. 2021 Mar 3;21(1):108. doi: 10.1186/s12893-021-01089-3.
BACKGROUND
Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures.
METHODS
We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients.
RESULTS
The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h.
CONCLUSION
Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.
背景
气管支气管异物吸入（TFBA）是儿童的危急重症，甚至危及生命。影响 TFBA 发生和预后的因素复杂，本研究旨在探讨华西地区影响 TFBA 临床特征的外在和内在因素，并提出潜在的有效干预措施。
方法
回顾性分析 2017 年 12 月至 2018 年 11 月我院耳鼻喉科在全身麻醉下经硬质支气管镜取出异物的儿童 TFBA 患者的临床资料，包括年龄、性别、临床症状、异物类型和部位、监护人、院前时间及居住地等。
结果
男性（72 例）与女性（53 例）比例为 1.4:1，年龄 1~3 岁者占 76%（95/125）。主要症状为咳嗽、持续发热、呼吸困难。硬质支气管镜检查发现 FB 最常见的部位是右主支气管（67 例，53.6%）。本研究中有机异物最常见。患者监护人在城乡差异有统计学意义（χ²=12.583，p=0.000），农村组（父母 16 例，祖父母 31 例）和城市组（父母 52 例，祖父母 26 例）监护人不同。农村组较城市组治疗延迟时间超过 72 h 的比例高，既往有异物吸入史的患儿较无异物吸入史的患儿治疗延迟时间超过 72 h 的比例高。
结论
儿科 TFBA 是耳鼻喉科常见的急症，年龄、性别、气管支气管解剖等生理因素属于内在因素，监护人、居住地、异物种类、院前时间等属于外在因素。外在和内在因素均影响 TFBA 的发生和进展，控制外在因素采取有效的干预措施极为重要，可降低发病率和死亡率。
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