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1岁女婴左肺去哪儿了?家有萌宝的爸妈都要引起警惕

2017-09-03 07:55:54   中国青年网

1岁多的女婴丫丫(化名)最近总是频繁咳嗽、喘气,原本活泼好动的她也变得安静起来。爸爸妈妈以为女儿患了重感冒,可是给她吃了几天药,不但没有好转反而越来越严重,怕耽误病情赶紧将孩子送到了医院。医生建议给小孩拍个胸片,可是检查结果却让所有人大吃一惊。

左肺怎么不见了?

罪魁祸首原来是半粒花生

“当时,孩子气促、口唇发绀,左侧肺部呼吸音消失,生命垂危。”四川省妇幼保健院重症医学科副主任谢成回忆说,小女孩由外院转运而来,经医院急诊科绿色通道快速进入重症医学科。医护人员立即给予孩子气管插管、呼吸机辅助通气治疗,在维持孩子的氧合前提下,放射科顺利完成了床旁胸片检查,而胸片的结果却让在场所有人捏了一把汗:孩子的左肺竟然“不见了”!

只有找到原因,才能帮助孩子脱离生命危险。医疗团队紧张地进行鉴别,逐一排除各种可能常见病因。结合小女孩的年龄特点,大家考虑气道异物可能性最大。但是无论怎样追问孩子的父母,都坚决否认异物呛入病史。为明确诊断,谢成决定立即进行床旁纤维支气管镜探查气道情况,显示屏上看到的一幕,再次令在场工作人员大吃一惊。原来孩子的左侧主支气管被完全堵塞。

随后,重症医学科又同儿外科、儿科、耳鼻喉科、麻醉科等多学科专家一起讨论孩子的病情,基本排除肺发育异常和肿瘤的可能性,方向最终锁定支气管内异物或是塑型性支气管炎。此时,医疗团队面对的最大困惑就是在各种不确定性中如何最大限度降低风险,挽救孩子的生命。

在与家属充分沟通后,医疗团队做好突发情况的应急准备后,在ICU里对小女孩进行了床旁纤维支气管镜取异物术。手术中,医生一边严密观察孩子生命体征,一边小心翼翼钳取堵塞物,将堵塞的东西一点点取出后,才发现造成孩子生命危险的罪魁祸首,原来就是小小的半粒花生米,以及围绕着花生米周围异常粘稠的痰栓。

当左主支气管的堵塞物全部清除后,气道内又涌出大量的脓痰,医生继续利用纤维支气管镜给予气道灌洗治疗,清除脓痰后孩子左肺的通气得到改善。整个手术持续近2个小时,术后1小时复查胸片,孩子的左肺又“回来”了。经过医护人员的精心护理,以及呼吸机辅助通气、抗感染治疗等,小女孩病情迅速好转,在两周后,痊愈出院。

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