Hong Ping-Yang, Wang Ling, Du Yan-Ping, Wang Miao, Chen Yi-Yuan, Huang Mao-Hong, Zhang Xiao-Bin
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 201, Hubin Nan Road, Siming District, Xiamen, Fujian, China.
The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Sci Rep. 2024 Apr 25;14(1):9493. doi: 10.1038/s41598-024-60307-z.
The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.
老年人气管支气管异物的症状不典型，因此常被漏诊或误诊。本研究旨在描述老年人气管支气管异物吸入的临床特征。我们回顾性分析了诊断为气管和支气管异物的老年患者（年龄≥65岁）的临床资料。数据包括年龄、性别、临床症状、异物类型和位置、院前病程、胸部CT、支气管镜检查结果以及取出这些老年患者气管和支气管异物的频率和工具。所有患者均随访半年。纳入59例病例，其中只有32.2%有明确的误吸史。病程>30天的患者占27.1%。27.1%的患者有中风病史，23.8%有阿尔茨海默病。关于临床症状，患者主要表现为咳嗽和咳痰。最常见的CT表现是密度异常影（37.3%）和肺部浸润（22.0%）。在支气管镜检查下，52.5%的患者观察到脓性分泌物，45.8%观察到肉芽组织增生。食物（55.9%）是最常见的异物，包括海鲜壳（5.1%）、骨头（20.3%）、假牙（18.6%）和药片（20.3%）。支气管镜下异物取出成功率为96.7%，28.8%的异物在左侧，69.5%在右侧。5.1%的老年患者需要硬支气管镜检查，6.8%需要两次支气管镜检查。在老年人群中，气管异物因非特异性临床表现和误吸史较少而难以诊断，具有挑战性。这些病例主要由食物颗粒构成，明显倾向于左支气管树，需要熟练的支气管镜处理，偶尔需要复杂的方法才能成功取出。
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