1、气管异物气管异物第1页/共35页 Foreign body aspiration can result a spectrum of changes,from minimal symptoms,to respiratory compromise,failure,and even death.第2页/共35页Etiology Foreign body aspiration is most common in children aged 6 months to 4 years.They lack molars for proper grinding of food.They tend to be r
2、unning 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页/共35页Etiology Adults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Menta
3、l retardation Alcoholism Psychoses Neurologic disorders第4页/共35页 A drawing pin in the left main bronchus A peanut in the right main bronchus第5页/共35页Anatomy Most foreign bodies lodged distal to the larynx and trachea in the right mainstem bronchus.The diameter of the right main bronchus is larger than
4、 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 likely to be located to the left of midline rather than to the right.第6页/共35页Pathophysiology Aspirated foreign bodies most commonly are
5、lodged in the right main stem and lower lobe.Peanuts are by far the most commonly aspirated material in children,followed by organic material such as sunflower seeds,pieces of vegetables,and hazelnuts.In adults,vegetable matter,meat,and bones rank highest,followed by dental and medical appliances.As
6、piration of teeth after trauma is observed occasionally.第7页/共35页Clinical Features Tracheal foreign bodies An 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页/共35页Clinical Features Bronchial foreign bodies
7、 Three distinct stages of a foreign body accident:Initial phase-Choking and 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 wee
8、ks.Complications phase-Foreign body producing erosion or obstruction leading to pneumonia,atelectasis,or abscess.第9页/共35页Clinical Features Initial symptoms Cough and dyspnoea occur at the time of accident.Bloodstained expectoration is sometimes present.第10页/共35页Clinical Features General symptoms Cou
9、gh with or without dysponea.Expectoration.Asthmatoid wheeze.第11页/共35页Clinical Features Special symptoms Depend upon whether the foreign body is of non-vegetable or of vegetable nature.第12页/共35页Clinical Features Non-vegetable foreign bodies.Their progress depends upon their size and shape.Little or n
10、o 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页/共35页 Atelectasis occurs if the lobe of the lung is completely obstructed,with subsequen
11、t danger of infection and the formation of a lung abscessClinical Features第14页/共35页Clinical Features An obstructive emphysema occurs if a lobe is only partially obstructed.inspirationexpiration第15页/共35页Clinical Features Vegetable foreign bodies Vegetable matter tends to be the most common airway for
12、eign 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 a specific allergic reaction to the vegetable oil liberated by the swelling object.Symptoms of acute tracheitis and bronchitis may be present.第16
13、页/共35页Clinical Features Imaging Studies:Posteroanterior and lateral chest radiographs are an adjunct to the history and physical examination in patients in whom foreign body aspirations are suspected.Chest radiographs(inspiratory and expiratory films)demonstrate atelectasis on inspiration and hyperi
14、nflation on expiration with a foreign body obstructing the bronchus.第17页/共35页Neurologic disordersThis-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 aspir
15、ated.Mediastinal shift.Tracheal foreign bodiesThis-may be a specific allergic reaction to 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-Fore
16、ign body producing erosion or obstruction leading to pneumonia,atelectasis,or abscess.Clinical Features X-ray Radiopaque foreign body.Atelectasis.Obstructive emphysema.Mediastinal shift.A patch of pneumonitis.第18页/共35页 Radiopaque foreign body第19页/共35页 Atelectasis.第20页/共35页Emphysema3 days after remov
17、al第21页/共35页 Mediastinal shift.第22页/共35页 Complete atelectasis of the left lung,with a mediastinal shift towards the left lung.第23页/共35页 A patch of pneumonitis.第24页/共35页Emphysema5 days after removal第25页/共35页Treatment Initial supportive therapy Oxygen administration.Cardiac monitor.Pulse oximetry.Antib
18、iotics and steroids.Removal of the foreign body第26页/共35页Radiopaque foreign body.This-may be a specific allergic reaction to the vegetable 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 mou
19、th during cough.An audible slap heard at the open mouth during cough.This-may be a specific allergic reaction to the vegetable oil 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 bron
20、chial mucosa.There is always an intense inflammatory reaction of the trachea and bronchial mucosa.Clinical FeaturesThey lack molars 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
21、common airway foreign body;peanuts are the most common food item aspirated.In adults,vegetable matter,meat,and bones rank highest,followed by dental and medical appliances.Expectoration.Removal of the foreign body Removal through a bronchoscope.Removal by thoracotomy.Tracheostomy.Treatment第27页/共35页T
22、reatment Removal through bronchoscope第28页/共35页 Tracheostomy Tracheostomy may be necessary if oedema of the larynx develops,either before or after bronchoscopy.Treatment第29页/共35页 Removal by thoracotomy The foreign body is small and locate in the lower-lobe bronchus.The foreign body is too large to re
23、move by bronchoscope.Treatment第30页/共35页Etiology Adults who are unable to protect the airway,are also at risk of aspiration due to decreased airway protective mechanisms.Mental retardation Alcoholism Psychoses Neurologic disorders第31页/共35页Clinical Features Non-vegetable foreign bodies.Their progress
24、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页/共35页Clinical Features Vegetable foreign bo
25、dies 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 a specific allergic reaction to the vegetable oil liberated by the swelling object.Sy
26、mptoms of acute tracheitis and bronchitis may be present.第33页/共35页Clinical Features Imaging Studies:Posteroanterior and lateral chest radiographs are an adjunct to the history and physical 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34页/共35页 Mediastinal shift.第35页/共35页
