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幼儿咳嗽近20天不见好转 竟是气管呛入花生

2017-09-17 08:01:38   中国青年网

本报9月15日讯(记者 张文举 通讯员 王慧丽) 1岁8个月的幼儿铭铭反复咳嗽近20天不见好转,一检查才发现,竟然是花生呛在了气管里。9月14日,长治市妇幼保健院医生为铭铭做了支气管镜异物取出术,成功将花生取出。

8月28日,铭铭在家吃花生时因为说笑,突然引发了一阵剧烈呛咳,随之吐出了一些花生碎屑,当时再无其它明显不适,家人也没有当回事。

然而,从那天以后,铭铭就开始反反复复地咳嗽、喘息。起初,家长以为孩子感冒了,带孩子到当地县医院治疗,被诊断为支气管炎,但孩子吃了半个月的药始终未见好转。

9月12日,家长带铭铭去了长治市妇幼保健院儿内一科,胸部CT气道重建提示:右侧主支气管有异物,右侧肺气肿。

哪来的异物?家长仔细回忆,终于想起前段时间吃花生发生呛咳的事情。

由于患儿年龄小,气道狭小,且异物吸入时间长,会与周围组织粘连,加之肉芽组织生成,异物取出难度很大,但情况紧急,需赶紧将异物取出。长治市妇幼保健院立即组织内镜室、麻醉科、儿科等相关科室专家开展讨论,迅速确定详细的应急预案,并定于9月14日给小铭铭做支气管镜异物取出术。

9月14日下午,经过精心的术前准备,由儿内一科副主任丁晚玲娴熟操作,首先在支气管镜下支气管分叉附近找到了异物,但由于呛入气管的花生已被增生的肉芽包裹,孩子气管又比较细,手术难度很大。最终,在多名医护人员的全力配合下,丁晚玲终于将那颗花生夹住了。然而,就在花生即将取出声门的关键时候,钳子突然卡在了喉罩边缘,任应斌主任眼疾手快一把将喉罩连同钳子一起取了出来,这才化险为夷,避免了花生再次掉到气管里。孩子在整个手术过程中没有任何不适,术后,孩子体温恢复正常,也停止了咳嗽。至此,小铭铭面临的“危机”终于解除了。此次手术为软式内镜下支气管异物取出,是长治市首例小儿支气管异物取出术。

○温馨提示

一旦出现气道异物应及时就医治疗

气道异物是儿童常见急症,其中以支气管异物最常见,发病急,变化快,是低龄儿童意外死亡的主要原因之一。支气管异物会导致通气功能障碍、呼吸功能不全等并发症,严重时心率下降、心跳骤停,危及生命,异物一旦活动随时有窒息的风险。如果不能及时发现,导致反复咳嗽、肺炎、肺脓肿,就会影响肺的功能,严重的需要将整个肺叶切除。

长治市妇幼保健院提醒广大家长,气管支气管异物常发生于儿童,首先是由于小儿的咀嚼功能及喉反射功能不健全,较硬食物未经咀嚼而咽下,容易发生误吸;其次,儿童喜欢将小玩具或食物含在口中,突然受到惊吓,或者哭闹、大笑时易将口含物吸入。日常生活中,家长要注意孩子的护理,避免食物等吸入,一旦出现气道异物,应及时就医,别错过最佳治疗时机。

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