Tracheal and bronchial foreign bodies in children
Introduction
Introduction to children's trachea and bronchial foreign bodies Trachea, bronchial foreign body (foreignbodiesinthetracheaandbronchi) is one of the common emergency diseases in pediatrics, can cause sudden death in children, more common in children under 5 years old, the severity depends on the nature of foreign bodies and the degree of airway obstruction, light can cause Pulmonary damage, severe cases can suffocate and die, foreign bodies are endogenous and exogenous. Endogenous foreign bodies are pseudomembranes, dryness, blood clots, pus, vomit, etc., which occur due to inflammation of the respiratory tract. Exogenous foreign bodies are various objects that are inhaled by the mouth. basic knowledge Proportion of the disease: the probability of illness in young children is 0.0003% Susceptible people: children Mode of infection: non-infectious Complications: emphysema, bronchitis, lung abscess
Cause
Pediatric trachea, bronchial foreign body etiology
Endogenous factors (35%):
Less common, such as bronchial lymph nodes and various granulations caused by inflammation, pseudomembranes, secretions and cognac.
Exogenous factors (55%):
More common, its variety, can be divided into solid, liquid, and can be divided into plant, animal, mineral, chemical, etc., clinical findings such as melon seeds, peanuts, soybeans, chestnuts, orange kernels, corn kernels , bone tablets, pushpins, pins, hairpins, small balls, plastic caps, whistle, etc.
Pathogenesis
Pediatric dental caries have not erupted, chewing function is poor; throat protective reflex function is poor; children love to cry and laugh when eating; school-age children like to put some small toys, caps, whistle, etc. in the mouth, when they cry, laugh and panic When inhaling deeply, it is easy to inhale foreign matter into the trachea. In severe or comatose children, due to weakening or disappearance of swallowing reflexes, occasionally vomit, blood, food, teeth, etc. are plunged into the trachea. Clinically, there are also comatose children due to mites. Ascending into the trachea.
Prevention
Childhood trachea, bronchial foreign body prevention
Foreign bodies in the respiratory tract are completely preventable. Parents and childcare workers should be widely educated. Children under the age of 3 have not yet developed their teeth. They should not be given peanuts, seeds, beans and other foods with nuclear. When eating in children Don't run around, so as not to inhale food when you fall, don't be scared when eating, amused or scolded, so as not to cry, laugh and suck, educate children to get rid of bad habits such as caps, whistle and small toys. Items that may be inhaled or swallowed by young children should not be used as toys. Special care should be taken when eating critically ill and comatose patients to prevent aspiration.
Complication
Pediatric trachea and bronchial foreign body complications Complications emphysema bronchitis lung abscess
Large foreign bodies can suffocate; can produce bronchial obstruction symptoms such as emphysema; can cause trachea, bronchitis and pneumonia; severe cases can be complicated by lung abscess and pus and pneumothorax; chronic bronchitis, chronic pneumonia, bronchiectasis, etc. can also occur.
Symptom
Pediatric trachea, bronchial foreign body symptoms Common symptoms, asthma, dyspnea, hoarseness, obstruction, tracheal obstruction, open mouth, breathing, cough, throat, snoring, tracheal carina, damage above the trachea can be heard...
After the foreign body enters the trachea, different symptoms occur depending on the size of the foreign body and the part staying in the trachea. The tracheal mucosa is stimulated to cause severe cough, followed by vomiting and difficulty in breathing. After a while, the symptoms are gradually reduced or relieved, such as foreign body. Large, incarcerated in the throat trachea, can immediately suffocate death; small, sharp foreign objects incarcerated in the throat, in addition to inspiratory dyspnea and throat, most of them have hoarseness or even a loss of sound, foreign matter stays longer People may have symptoms such as pain and hemoptysis. Foreign bodies stay in the trachea. They often cause severe coughing cough with breathing movement. Cough and dyspnea during sleep are all relieved. Breathing difficulties are mostly inspiratory, but if foreign bodies are present, Larger and embedded in the tracheal carina, it is mixed dyspnea, inhalation, exhalation are difficult, while exhaling has a wheezing sound, very similar to bronchial wheezing, should pay attention to identification.
General tracheal foreign bodies have the following three typical symptoms:
1. Panting and wheezing: It occurs when the air passes through the blockage of foreign matter, and it is heard more clearly when breathing in the mouth.
2. Tracheal slap sound: Foreign matter occurs with the exhaled airflow under the glottis, which is more pronounced when coughing, and the foreign body is fixed without moving.
3. Tracheal impact: the principle is the same as the tracheal slap sound, the palpation trachea can have a sense of impact, the foreign body stops at one side of the bronchus, the child cough, dyspnea and wheezing symptoms are alleviated, called the asymptomatic period, only this period Mild cough and wheezing, and later due to foreign body blockage and inflammation, resulting in emphysema or atelectasis and other symptoms of bronchial obstruction, foreign body longer, inflammation increased, especially with fatty acid-containing plant-like foreign bodies, such as peanuts Wait for it, stimulate the tracheal mucosa, make it congested and swollen, secrete serous or purulent secretions, mild bronchitis and fatty pneumonia; severe cases can be complicated by lung abscess and pus gas chest, increase breathing difficulties, and cause systemic poisoning Symptoms, such as high fever, generally foreign bodies stay in the bronchial tubes, a small number of small foreign bodies such as pins, etc., can enter the segmental bronchus, such as the middle and lower lobe basement, small mineral foreign bodies, not enough to block the bronchi, can be significant Symptoms, after weeks or months, lesions in the lungs, repeated fever in children, cough, cough, chronic bronchitis, chronic pneumonia, bronchiectasis or lung pus Such symptoms; for typical cases, according to medical history, symptoms, signs can be diagnosed, chronic cases of bronchial foreign body, often misdiagnosed as pneumonia, if necessary, for chest X-ray or film, especially chest X-ray is important, if necessary, bronchoscopy .
Examine
Examination of children's trachea and bronchial foreign bodies
When the foreign body fails to be taken out in time and the infection is secondary, the blood is often infected.
X-ray inspection
(1) fluoroscopy: the main method for X-ray diagnosis of trachea and bronchial plant foreign body, can repeatedly observe the movement of the mediastinum, heart and diaphragm.
1 tracheal foreign body: under fluoroscopy can show bilateral lung transfusion brightness increased, the horizontal position is low, because the trachea is blocked, the lungs become darker and the lateral sputum rises when the end of exhalation is not obvious, the heart shadow has abnormal size (normal pediatric suction When the gas is reduced, the heart shadow is reduced, and the heart shadow is increased when exhaling; when the patient exhales, the cross-sectional diameter of the heart shadow is reduced compared with the inhalation, that is, the so-called heart shadow has an abnormal size.
2 bronchial foreign body:
A. Obstructive emphysema: obstructive emphysema on the affected side. When seen through the fluoroscopy, the lungs of the affected side have high brightness, the diaphragm is low, the mobility is limited, the mediastinum is displaced to the healthy side, and the mediastinum is inhaled. The affected side oscillates and then returns to its original position.
B. Obstructive atelectasis: obstructive atelectasis on the affected side of bronchial foreign body. In the fluoroscopy, the lung light of the affected side is reduced, the diaphragm is rising, the compensatory emphysema is on the healthy side, and the mediastinum is displaced to the affected side. When inhaling, the mediastinum swings toward the affected side.
(2) Chest X-ray film: If you need to take a chest X-ray film, you must take a picture of the inhalation and exhalation at the same time, take the positive and lateral slices, and determine the location, size and shape of the foreign object. Foreign bodies in the trachea or in the esophagus, respiratory obstruction, such as emphysema, atelectasis and mediastinal shift, etc., due to different clogging of different lobes in different lobes, different pathological changes may occur in each lobes, for example Right bronchial foreign body, X-ray examination showed the right upper lobe atelectasis, while the right middle lobe was emphysema.
2. CT: With the clinical application of spiral CT in recent years, it has important value in the judgment and localization of foreign bodies in children's respiratory tract. The three-dimensional reconstruction of the simulated bronchoscope can show the location and size of the foreign body, which is difficult to diagnose and shape. The operation of specific foreign bodies is instructive.
3. Bronchoscopy: If there is a suspected trachea or bronchial foreign body, bronchoscopy should be performed.
Diagnosis
Diagnosis and diagnosis of tracheal and bronchial foreign bodies in children
diagnosis
1. History of aspiration of foreign body: The history is an important basis for the diagnosis of foreign bodies in the respiratory tract. Generally, parents can detail it. A few parents forget it afterwards, or they dont see it. They need to ask repeatedly. If there is no upper respiratory tract infection, suddenly there is no sudden cough. Foreign bodies, some children can not tell the inhalation of foreign bodies, and a history of severe coughing in healthy children, but there are lesions in the lungs, neither like tuberculosis nor typical bronchial pneumonia or other lung diseases, such cases should be suspected Foreign body, bronchoscopy can confirm the diagnosis.
2. Chest signs: Due to different cases, depending on the location and nature of the obstruction, foreign bodies that are active in the trachea can be beaten in addition to coughing, and the lungs have different levels of breath sounds and humming. Foreign body obstruction of one side of the bronchus, can show one side or a leaf of atelectasis or emphysema signs, the side of the lungs percussion or dullness or drum sound, depending on lung lesions, but the breath sounds are reduced, if there is success If you have an infection, you can smell snoring or wheezing. Because of bronchitis caused by fatty acid foreign matter, after taking out foreign bodies, you can smell small and medium vesicles. This is caused by the discharge of the secretions, which is generally difficult to listen to before surgery. To.
3. Auxiliary examination: If there is suspected trachea or bronchial foreign body, bronchoscopy should be performed. X-ray examination can determine the location, size and shape of the foreign body, including fluoroscopy and X-ray positive lateral radiograph. Photographs of qi and exhalation, if necessary, spiral CT examination, have clinical significance for the diagnosis of difficult to diagnose and morphologically specific foreign bodies.
Differential diagnosis
1. Bronchial asthma: There is often a history of wheezing, there is wheezing and expiratory dyspnea, and severe cases are sitting and breathing. After treatment with aminophylline or hormones, most of the symptoms can be alleviated in a short period of time. Breathing difficulties caused by foreign bodies in the respiratory tract are ineffective.
2. Bronchitis and pneumonia: bronchial foreign body is easily misdiagnosed as pneumonia, but pneumonia often has a history of upper respiratory tract infection and fever. The lungs often have thick, fine squeaks, but no obvious unilateral breath sounds, and antibiotics. After treatment, the inflammation was quickly controlled and the condition improved.
