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目的 总结儿童支气管异物合并皮下气肿、纵隔气肿和气胸的处理方法。方法 回顾 1987年 10月至 2 0 0 0年 6月北京儿童医院 19例支气管异物合并皮下气肿、纵隔气肿和气胸患儿的治疗经过。结果 合并皮下气肿 (4例 )、纵隔气肿 (3例 )和合并皮下气肿纵隔气肿 (9例 )的 16例患儿 ,15例因一般情况良好、无明显呼吸困难及肺压迫症状 ,未做特殊处理 ;仅 1例因皮下和纵隔气肿面积大 ,经抗炎治疗 3d ,待气肿面积逐渐减少后 ,全麻下行气管镜检术 ;3例气胸患儿中有 2例患侧肺分别被压迫 30 %和 4 0 % ,未造成明显呼吸困难 ,故未予特殊处理 ,另 1例患侧肺被压迫 80 % ,呼吸困难明显 ,给予胸腔穿刺抽气后 ,全麻下行气管镜检术。 19例均经气管镜取出异物并治愈出院。结论 支气管异物合并皮下气肿、纵隔气肿和气胸时 ,大多数无须特殊处理 ,经一般处理后在 2 4h内实施气管镜检术 ;只有少数患儿呼吸困难与压迫症状明显者 ,经一般处理后 ,包括穿刺抽气 ,再于全麻下行气管镜取出异物。
Objective To summarize the treatment of children bronchial foreign body complicated with subcutaneous emphysema, mediastinal emphysema and pneumothorax. Methods From October 1987 to June 2004, 19 children with bronchial foreign bodies complicated with subcutaneous emphysema, mediastinal emphysema and pneumothorax were treated in Beijing Children’s Hospital. Results Sixteen children with subcutaneous emphysema (4 cases), mediastinum emphysema (3 cases) and mediastinal emphysema (9 cases) were complicated with 15 cases because of their good general condition, no obvious dyspnea and symptoms of pulmonary compression , No special treatment; only 1 case of large area due to subcutaneous and mediastinal emphysema, anti-inflammatory treatment by 3d, to be gradually reduced after the area of emphysema, underwent bronchoscopy under general anesthesia; 3 cases of pneumothorax in children with 2 patients Side lungs were oppressed 30% and 40%, did not cause significant breathing difficulties, it was not given special treatment, the other side of the affected side of the lung was 80% oppression, significant dyspnea, given thoracentesis after aspiration, under general anesthesia tracheal Microscopy. 19 cases were removed by foreign body tracheoscope and cured. Conclusion Bronchial foreign body combined with subcutaneous emphysema, pneumomediastinum and pneumothorax, most without special treatment, the general treatment within 24 hours after the implementation of tracheoscope; only a small number of children with dyspnea and oppression symptoms were obvious, after the general treatment After, including puncture aspiration, and then under general anesthesia bronchoscopy remove foreign body.