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儿童异物吸入——回顾性研究和管理新进展。

Foreign Body Aspiration in Children-Retrospective Study and Management Novelties.

机构信息

Department of Mother and Child Medicine, University of Medicine and Pharmacy "Gr.T.Popa", 700115 Iasi, Romania.

Clinical Hospital of Emergency for Children Sfanta Maria, 700309 Iasi, Romania.

出版信息

Medicina (Kaunas). 2023 Jun 9;59(6):1113. doi: 10.3390/medicina59061113.

Abstract

Foreign body aspiration (FBA) is a frequent diagnosis in children. In the absence of other lung conditions, such as asthma or chronic pulmonary infections, this manifests as a sudden onset of cough, dyspnea, and wheezing. The differential diagnosis is based on a scoring system which takes into account the clinical picture as well as the radiologic aspects. The treatment that is considered the gold-standard for FBA in children remains to be rigid fibronchoscopy, however it comes with several potentially crucial local complications such as airway edema, bleeding, and bronchospasm, along inherent issues due to general anesthesia. : Our study is a retrospective study analyzing the medical files of the cases from our hospital over the span of 9 years. The study group consisted of 242 patients aged 0-16 years diagnosed with foreign body aspiration in the Emergency Clinical Hospital for Children "Sfânta Maria" Iași, between January 2010-January 2018. Clinical and imaging data were extracted from the patients' observation sheets. In our cohort, the distribution of children with foreign body aspiration was uneven, with the highest incidence being reported in children from rural areas (70% of cases), whereas the most affected age group was 1-3 years, amounting to 79% of all cases. The main symptoms which led to emergency admittance were coughing (33%) and dyspnea (22%). The most important factors that determined the unequal distribution were socio-economic status, which relates to a lack of adequate supervision by parents, as well as the consumption of food inappropriate for their age. Foreign body aspiration is a major medical emergency that may be associated with dramatic clinical manifestations. Several scoring algorithms designed to establish the need for bronchoscopy have been proposed, taking into account both the clinical and radiological results. The issue with asymptomatic or mild symptomatic cases, as well as difficulties managing cases with radiolucent foreign bodies, remains a challenge.

摘要

异物吸入(FBA)是儿童的常见诊断。在没有其他肺部疾病(如哮喘或慢性肺部感染)的情况下,其表现为突然咳嗽、呼吸困难和喘息。鉴别诊断基于评分系统,该系统考虑了临床情况和影像学方面。对于儿童的 FBA,被认为是金标准的治疗方法仍然是刚性纤维支气管镜检查,但它伴随着几个潜在的关键局部并发症,如气道水肿、出血和支气管痉挛,以及由于全身麻醉而固有的问题。:我们的研究是一项回顾性研究,分析了 2010 年 1 月至 2018 年 1 月期间在雅西“圣玛丽亚”儿童急诊临床医院诊断为异物吸入的 242 例 0-16 岁患者的病历。从患者的观察表中提取临床和影像学数据。在我们的队列中,异物吸入儿童的分布不均匀,农村地区的发病率最高(70%的病例),而受影响最大的年龄组是 1-3 岁,占所有病例的 79%。导致急诊入院的主要症状是咳嗽(33%)和呼吸困难(22%)。决定这种不均匀分布的最重要因素是社会经济地位,这与父母缺乏适当监督有关,以及食用与年龄不符的食物。异物吸入是一种严重的医疗急症,可能与戏剧性的临床表现有关。已经提出了几种评分算法,以根据临床和影像学结果来确定是否需要进行支气管镜检查。无症状或症状轻微的病例以及处理不透射线异物的困难仍然是一个挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1667/10302152/54880d2ba18b/medicina-59-01113-g001.jpg

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