摘要
目的探讨老年患者气道异物吸入的临床特点，提高对老年气道异物吸入患者的认识。方法回顾性分析2000年1月1日-2016年12月31日北京大学第一医院收入院诊治的20例成人气道异物患者的临床资料，分析老年患者的临床特点。结果①成人气道异物患者临床表现不典型，常见症状为咳嗽、咳痰、呼吸困难、咯血、发热。②成人气道异物吸入患者吸入史多不明确，老年组4例（44％）、非老年组7例（64％）能够提供吸入病史。③成人气道异物吸入容易被误诊，17例（85％）按照肺炎、肺癌、支气管哮喘等其他疾病治疗，延迟诊断时间为5天至10年不等。④4例（20％）患者经胸片直接发现气道异物，异物性质为牙齿或金属；胸部CT发现气道异物阳性率在老年组为56％（5例），非老年组为91％（10例）。⑤异物性质和部位：11例（55％）的异物为食物，老年组中有2例（10％）为牙齿吸入；气道异物共有11例（55％）进入右侧主支气管及其分支。⑥所有患者均进行支气管镜检查和治疗，19（95％）例患者接受纤维支气管镜检查和治疗，1例（5％）患者接受硬质支气管镜检查和治疗；12例（60％）经1次支气管镜检查和镜下治疗成功取出异物，8例（40％）患者经两次支气管镜检查和镜下治疗成功取出异物。结论成人气道异物吸入的临床表现不典型，尤其老年患者是气道异物吸入的高危人群且临床表现、吸入史及影像学检查更不典型，容易被误诊。对于有高危因素的患者应积极进行支气管镜检查进一步明确诊治。
Objective To analyze the clinical features of foreign body aspiration into lower airway. Methods Twenty eases of adults with foreign body aspiration into lower airway admitted into Peking University First Hospital from Jan, 1, 2000 till now, were retrospectively analyzed. Results （1） The clinical presentations of foreign body aspiration into lower airway were atypical. The common symptoms were cough, sputum, dyspnea, hemoptysis, and fever. （2） The aspiration history were not clear. Only 4 cases （44%） in geriatric group and 7 cases （64%） in non-geriatric group had clear aspiration history. （3） Airway foreign body aspiration were easily to be misdiagnosed. 17 eases （85%） were misdiagnosed as pneumonia, lung cancer, asthma and et al for 5 days to 10 years. （4） Chest X-ray could detect foreign body in 4 cases （20%） which were metal or teeth. Chest CT could detect demonstrate foreign body in 56% cases in geriatric group and 91% in non-geriatric group. （5） In 55% cases, the foreign body was food and 55% cases of foreign body were located in right main bronchi and its sub-branches. （6） All of the patients accepted bronchoscopy examination and treatment. In 60% cases, foreign body was removed successfully at initial treatment and 40% cases accepted the second time of bronchoscopy.Conclusions The clinical features of foreign body aspiration in adults were atypical, especially for the geriatric patients. Bronchoscopy should be applied in the suspected patients, especially for those with high risk of aspiration.
出处
《中国急救复苏与灾害医学杂志》
2017年第4期330-334,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
气道异物
临床特点
成人
老年人
Foreign body aspiration into the lower airway
Clinical features
Adults
Geriatric patients
