目的 探讨儿童气管支气管异物的临床特征.方法 回顾性分析天津市儿童医院2011年6月至2016年6月行支气管镜诊断和治疗的84例气管支气管异物患儿的一般情况、吸入史、病程、异物种类、异物滞留部位、临床表现及影像学特征.结果 儿童气管支气管异物好发于男童(男∶女为2.23∶1),主要发病年龄为6个月至3岁(89.29％),患儿居住地农村多于城市(城市30.95％,农村69.05％),尤以农村男童为高发人群(P＜0.05).能够准确提供异物吸入病史有助于早期确诊及治疗(P＜0.05).吸入异物种类以可食性异物为主,以坚果类多见.气管支气管异物滞留于左、右主支气管的比例差别不大,但滞留于右侧叶支气管病例数多于左侧.不同的气道滞留部位所引起的临床症状有区别.最常见症状为咳嗽(98.81％)和喘息(58.33％),影像学有肺气肿(55.95％)表现.结论 气管支气管异物重点防控对象为农村3岁以下的男童,应加强监护人对于气管支气管异物的重视,减少幼儿对坚果类食物的接触.对于反复咳嗽、喘息、查体单侧呼吸音减弱,影像学伴有肺气肿、肺不张的患儿,应重视异物吸入史或呛咳史,积极行支气管镜检查以明确诊断及治疗.%Objective To evaluate the clinical characteristics of children with trachea or bronchus foreign body.Methods The data of 84 children with confirmed diagnosis of trachea or bronchus foreign body was retrospectively analyzed in this study form Jun 2011 to Jun 2016 in Tianjin Children Hospital,including general situation,history of foreign body aspiration,medical history,course of disease,foreign body property,clinical and imaging characteristics.Results The rate for tracheobronchial foreign body occurring in boys and girls were 2.23:1 with the main incidence age of 6 months to 3 years old.The incidence rate in countryside was higher than that in city (69.05％ vs.30.95％),especially boys in countryside.Children who are able to provide an accurate history of foreign body aspiration may be helpful in early diagnosis and treatment of trachea or bronchus foreign body (P ＜ 0.05).The main type of foreign body was food,especially nuts.The proportion of bronchial foreign body which remained in the left or right main bronchial tubes was not different,but the number of cases in right lobe was higher than that in the left.The clinical symptom was different according to the different lesions with block of foreign bodies.The main symptom was cough (98.81％) and breezing(58.33％),with the imaging characteristics of emphysema (55.95％).Conclusion In prevention and control of tracheobronchial foreign bodies,boys under the age of 3 should be paid most attention to in rural areas.The children should be reduced contact with nuts food.The guardian must attach more importance to tracheobronchial foreign body.For children with symptom of cough and wheezing weakening breathing sounds on single side by physical examination,emphysema and pulmonary atelectasis on imaging,health providers should pay attention to the history of foreign body aspiration or cough history,and should actively perform bronchoscopy for early diagnosis and treatment.
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