儿童钡剂误吸病例分析及儿科纤维支气管镜治疗临床效果评估

doi:10.3877/cma.j.issn.1673-5250.2008.05.114

目的

探讨儿童钡剂误吸的原因及纤维支气管镜灌洗治疗的效果评估。

方法

研究对象为2002年2月至2006年10月在北京儿童医院被确诊为钡剂误吸14例患儿，对其进行回顾性分析，并进行追踪随访。

结果

① 儿童钡剂误吸的发生以婴幼儿为主，新生儿期发生最多，其次为小婴儿，学龄儿少见；②吞咽功能不协调，胃、食管反流是造成钡剂误吸的主要原因；③儿童钡剂误吸的临床表现轻重程度与钡剂吸入量、发生误吸后与原发病的相互作用及治疗开始时间有关；④儿科纤维支气管镜灌洗治疗，可以有效洗出误吸钡剂。

结论

①儿童钡剂误吸的发生与年龄有关；②本组全部钡剂误吸儿童均为医源性；③早期、多次儿科纤维支气管镜灌洗治疗钡剂误吸有确切疗效。

关键词: 钡剂误吸, 儿童, 支气管镜, 灌洗

Objective

To explore reasons of barium sulphate aspiration in children and to investigate the treatment efficiency of bronchoalveolar lavage with pediatric bronchoscopy.

Methods

14 children with aspitated barium who were admitted in Beijing Children Hospital from February 2002 to October 2006 were retrospectively analyzed and all the patients were followed up.

Results

①The children aspirated barium mainly occurred in infants, which has the highest number of neonatal period, followed by small babys, school-age children were rare. ②The major reasons of the barium aspiration were the incoordination of swallowing function and gastroesophageal reflux. ③The clinical manifestations of the children with barium aspiration were due to the dose of the barium sulphate how much they had been aspirated, the interaction with the protopathy, and therapy time. ④Pediatric bronchoscope lavage treatment can effectively wash out barium.

Conclusions

①The children with barium aspiration were age-related. ②All the children with barium aspiration were iatrogenic. ③Early repeatedly pediatric bronchoscopy lavage treatment of aspirated barium had a exact curative.

Key words: barium sulphate aspiration, children, bronchoscopy, lavage

图1A　2个月男婴误吸钡剂1 d(病例1)

图1B　小儿纤维支气管镜灌洗2次后

图1C　小儿纤维支气管镜灌洗10次后

图1D　2岁后复查

图2A　3个月男婴，误吸钡剂2月余

图2B　肺CT

图2C　半年后复查

图2D　1岁半复查

图3A、图3B　5月男婴(病例10)上消化道造影时钡剂进入右主支气管及分支

图3C、图3D　灌洗3次后肺内未见钡剂影

图4A、图4B　7岁女孩胃管误插入气管后钡剂误吸的胸片正侧位(病例13)

图4C　纤维支气管镜灌洗出钡剂的沉淀

图5A　箭头所标为右下支气管基底段开口处白色分泌物附着

图5B　箭头所标为右中下支气管开口处白色分泌物附着

图5C、图5D　箭头所标为左下支气管开口黏膜粗糙

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The Analysis of Barium Sulphate Aspiration in Children and the Evaluation of Pediatric Bronchoscopy in the Treatment

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The Analysis of Barium Sulphate Aspiration in Children and the Evaluation of Pediatric Bronchoscopy in the Treatment