1、氣管異物第1頁/共35頁氣管異物第1頁/共35頁Foreign body aspiration can result a spectrum of changes, from minimal symptoms, to respiratory compromise, failure, and even death. 第2頁/共35頁Foreign body aspiration can reEtiologyForeign body aspiration is most common in children aged 6 months to 4 years. They lack molars for

2、 proper grinding of food. They tend to be running or playing at the time of aspiration. They tend to put objects in their mouth more frequently. They lack coordination of swallowing and glottic closure.第3頁/共35頁EtiologyForeign body aspiratioEtiologyAdults who are unable to protect the airway, are als

3、o at risk of aspiration due to decreased airway protective mechanisms. Mental retardationAlcoholismPsychosesNeurologic disorders第4頁/共35頁EtiologyAdults who are unable A drawing pin in the left main bronchusA peanut in the right main bronchus第5頁/共35頁A drawing pin in the left mainAnatomyMost foreign bo

4、dies lodged distal to the larynx and trachea in the right mainstem bronchus. The diameter of the right main bronchus is larger than the left.The angle of divergence from the tracheal axis is smaller on the right.Airflow through the right lung is greater than through the left. The carina is more like

5、ly to be located to the left of midline rather than to the right. 第6頁/共35頁AnatomyMost foreign bodies lodPathophysiologyAspirated foreign bodies most commonly are lodged in the right main stem and lower lobe. Peanuts are by far the most commonly aspirated material in children, followed by organic mat

6、erial such as sunflower seeds, pieces of vegetables, and hazelnuts.In adults, vegetable matter, meat, and bones rank highest, followed by dental and medical appliances. Aspiration of teeth after trauma is observed occasionally. 第7頁/共35頁Pathophysiology第7頁/共35頁Clinical FeaturesTracheal foreign bodiesA

7、n audible slap heard at the open mouth during cough.Palpable slap with respirations.Asthmatoid wheeze heard with the ear at the patients mouth.第8頁/共35頁Clinical FeaturesTracheal foreClinical FeaturesBronchial foreign bodiesThree distinct stages of a foreign body accident: Initial phase - Choking and

8、gasping, coughing, or airway obstruction at the time of aspiration Asymptomatic phase - Subsequent lodging of the object with relaxation of reflexes that often results in a reduction or cessation of symptoms, lasting hours to weeks.Complications phase - Foreign body producing erosion or obstruction

9、leading to pneumonia, atelectasis, or abscess.第9頁/共35頁Clinical FeaturesBronchial forClinical FeaturesInitial symptomsCough and dyspnoea occur at the time of accident.Bloodstained expectoration is sometimes present.第10頁/共35頁Clinical FeaturesInitial symptClinical FeaturesGeneral symptomsCough with or

10、without dysponea.Expectoration.Asthmatoid wheeze.第11頁/共35頁Clinical FeaturesGeneral symptClinical FeaturesSpecial symptoms Depend upon whether the foreign body is of non-vegetable or of vegetable nature.第12頁/共35頁Clinical FeaturesSpecial symptClinical FeaturesNon-vegetable foreign bodies. Their progre

11、ss depends upon their size and shape. Little or no inflammatory reaction occurs in the bronchial mucosa at first. Granulations may form later and cause haemoptysis. Cough, after its initial presentation, disappears but it returns if the object changes position. 第13頁/共35頁Clinical FeaturesNon-vegetabl

12、eAtelectasis occurs if the lobe of the lung is completely obstructed, with subsequent danger of infection and the formation of a lung abscessClinical Features第14頁/共35頁Atelectasis occurs if the lobeClinical FeaturesAn obstructive emphysema occurs if a lobe is only partially obstructed.inspirationexpi

13、ration第15頁/共35頁Clinical FeaturesAn obstructivClinical FeaturesVegetable foreign bodies Vegetable matter tends to be the most common airway foreign body; peanuts are the most common food item aspirated. There is always an intense inflammatory reaction of the trachea and bronchial mucosa. This-may be

14、a specific allergic reaction to the vegetable oil liberated by the swelling object. Symptoms of acute tracheitis and bronchitis may be present .第16頁/共35頁Clinical FeaturesVegetable forClinical FeaturesImaging Studies: Posteroanterior and lateral chest radiographs are an adjunct to the history and phy

15、sical examination in patients in whom foreign body aspirations are suspected. Chest radiographs (inspiratory and expiratory films) demonstrate atelectasis on inspiration and hyperinflation on expiration with a foreign body obstructing the bronchus.第17頁/共35頁Clinical FeaturesImaging StudiNeurologic di

16、sordersThis-may be a specific allergic reaction to the vegetable oil liberated by the swelling object.Vegetable matter tends to be the most common airway foreign body; peanuts are the most common food item aspirated.Mediastinal shift.Tracheal foreign bodiesThis-may be a specific allergic reaction to

17、 the vegetable oil liberated by the swelling object.TracheostomyA peanut in the right main bronchusAspirated foreign bodies most commonly are lodged in the right main stem and lower lobe.Complications phase - Foreign body producing erosion or obstruction leading to pneumonia, atelectasis, or abscess

18、.Clinical FeaturesX-rayRadiopaque foreign body.Atelectasis. Obstructive emphysema. Mediastinal shift. A patch of pneumonitis.第18頁/共35頁Neurologic disordersClinical FRadiopaque foreign body第19頁/共35頁Radiopaque foreign body第19頁/共3Atelectasis.第20頁/共35頁Atelectasis.第20頁/共35頁Emphysema3 days after removal第21

19、頁/共35頁Emphysema3 days after removal第Mediastinal shift.第22頁/共35頁Mediastinal shift.第22頁/共35頁Complete atelectasis of the left lung, with a mediastinal shift towards the left lung. 第23頁/共35頁Complete atelectasis of the leA patch of pneumonitis.第24頁/共35頁A patch of pneumonitis.第24頁/共3Emphysema5 days after

20、removal第25頁/共35頁Emphysema5 days after removal第TreatmentInitial supportive therapy Oxygen administration. Cardiac monitor.Pulse oximetry.Antibiotics and steroids.Removal of the foreign body第26頁/共35頁TreatmentInitial supportive thRadiopaque foreign body.This-may be a specific allergic reaction to the v

21、egetable oil liberated by the swelling object.The carina is more likely to be located to the left of midline rather than to the right.An audible slap heard at the open mouth during cough.An audible slap heard at the open mouth during cough.This-may be a specific allergic reaction to the vegetable oi

22、l liberated by the swelling object.The diameter of the right main bronchus is larger than the left.There is always an intense inflammatory reaction of the trachea and bronchial mucosa.There is always an intense inflammatory reaction of the trachea and bronchial mucosa.Clinical FeaturesThey lack mola

23、rs for proper grinding of food.Their progress depends upon their size and shape.Non-vegetable foreign bodies.Vegetable foreign bodiesVegetable matter tends to be the most common airway foreign body; peanuts are the most common food item aspirated.In adults, vegetable matter, meat, and bones rank hig

24、hest, followed by dental and medical appliances.Expectoration.Removal of the foreign bodyRemoval through a bronchoscope.Removal by thoracotomy.Tracheostomy. Treatment第27頁/共35頁Radiopaque foreign body.RemovaTreatmentRemoval through bronchoscope第28頁/共35頁TreatmentRemoval through bronTracheostomyTracheos

25、tomy may be necessary if oedema of the larynx develops, either before or after bronchoscopy.Treatment第29頁/共35頁TracheostomyTreatment第29頁/共35頁Removal by thoracotomy The foreign body is small and locate in the lower- lobe bronchus.The foreign body is too large to remove by bronchoscope.Treatment第30頁/共3

26、5頁Removal by thoracotomy TreatmeEtiologyAdults who are unable to protect the airway, are also at risk of aspiration due to decreased airway protective mechanisms. Mental retardationAlcoholismPsychosesNeurologic disorders第31頁/共35頁EtiologyAdults who are unable Clinical FeaturesNon-vegetable foreign bo

27、dies. Their progress depends upon their size and shape. Little or no inflammatory reaction occurs in the bronchial mucosa at first. Granulations may form later and cause haemoptysis. Cough, after its initial presentation, disappears but it returns if the object changes position. 第32頁/共35頁Clinical FeaturesNon-vegetableCli