气管异物.ppt

Foreignbodiesinthetracheaandbronchus,Foreignbodyaspirationcanresultaspectrumofchanges,fromminimalsymptoms,torespiratorycompromise,failure,andevendeath.,Etiology,Foreignbodyaspirationismostcommoninchildrenaged6monthsto4years.Theylackmolarsforpropergrindingoffood.Theytendtoberunningorplayingatthetimeofaspiration.Theytendtoputobjectsintheirmouthmorefrequently.Theylackcoordinationofswallowingandglotticclosure.,Etiology,Adultswhoareunabletoprotecttheairway,arealsoatriskofaspirationduetodecreasedairwayprotectivemechanisms.MentalretardationAlcoholismPsychosesNeurologicdisorders,Adrawingpinintheleftmainbronchus,Apeanutintherightmainbronchus,Anatomy,Mostforeignbodieslodgeddistaltothelarynxandtracheaintherightmainstembronchus.Thediameteroftherightmainbronchusislargerthantheleft.Theangleofdivergencefromthetrachealaxisissmallerontheright.Airflowthroughtherightlungisgreaterthanthroughtheleft.Thecarinaismorelikelytobelocatedtotheleftofmidlineratherthantotheright.,Pathophysiology,Aspiratedforeignbodiesmostcommonlyarelodgedintherightmainstemandlowerlobe.Peanutsarebyfarthemostcommonlyaspiratedmaterialinchildren,followedbyorganicmaterialsuchassunflowerseeds,piecesofvegetables,andhazelnuts.Inadults,vegetablematter,meat,andbonesrankhighest,followedbydentalandmedicalappliances.Aspirationofteethaftertraumaisobservedoccasionally.,ClinicalFeatures,TrachealforeignbodiesAnaudibleslapheardattheopenmouthduringcough.Palpableslapwithrespirations.Asthmatoidwheezeheardwiththeearatthepatientsmouth.,ClinicalFeatures,BronchialforeignbodiesThreedistinctstagesofaforeignbodyaccident:Initialphase-Chokingandgasping,coughing,orairwayobstructionatthetimeofaspirationAsymptomaticphase-Subsequentlodgingoftheobjectwithrelaxationofreflexesthatoftenresultsinareductionorcessationofsymptoms,lastinghourstoweeks.Complicationsphase-Foreignbodyproducingerosionorobstructionleadingtopneumonia,atelectasis,orabscess.,ClinicalFeatures,InitialsymptomsCoughanddyspnoeaoccuratthetimeofaccident.Bloodstainedexpectorationissometimespresent.,ClinicalFeatures,GeneralsymptomsCoughwithorwithoutdysponea.Expectoration.Asthmatoidwheeze.,ClinicalFeatures,SpecialsymptomsDependuponwhethertheforeignbodyisofnon-vegetableorofvegetablenature.,ClinicalFeatures,Non-vegetableforeignbodies.Theirprogressdependsupontheirsizeandshape.Littleornoinflammatoryreactionoccursinthebronchialmucosaatfirst.Granulationsmayformlaterandcausehaemoptysis.Cough,afteritsinitialpresentation,disappearsbutitreturnsiftheobjectchangesposition.,Atelectasisoccursifthelobeofthelungiscompletelyobstructed,withsubsequentdangerofinfectionandtheformationofalungabscess,ClinicalFeatures,ClinicalFeatures,Anobstructiveemphysemaoccursifalobeisonlypartiallyobstructed.,inspiration,expiration,ClinicalFeatures,VegetableforeignbodiesVegetablemattertendstobethemostcommonairwayforeignbody;peanutsarethemostcommonfooditemaspirated.Thereisalwaysanintenseinflammatoryreactionofthetracheaandbronchialmucosa.This-maybeaspecificallergicreactiontothevegetableoilliberatedbytheswellingobject.Symptomsofacutetracheitisandbronchitismaybepresent.,ClinicalFeatures,ImagingStudies:Posteroanteriorandlateralchestradiographsareanadjuncttothehistoryandphysicalexaminationinpatientsinwhomforeignbodyaspirationsaresuspected.Chestradiographs(inspiratoryandexpiratoryfilms)demonstrateatelectasisoninspirationandhyperinflationonexpirationwithaforeignbodyobstructingthebronchus.,ClinicalFeatures,X-rayRadiopaqueforeignbody.Atelectasis.Obstructiveemphysema.Mediastinalshift.Apatchofpneumonitis.,Radiopaqueforeignbody,Atelectasis.,Emphysema,3daysafterremoval,Mediastinalshift.,Completeatelectasisoftheleftlung,withamediastinalshifttowardstheleftlung.,Apatchofpneumonitis.,Emphysema,5daysafterremoval,Treatment,InitialsupportivetherapyOxygenadministration.Cardiacmonitor.Pulseoximetry.Antibioticsandsteroids.Removaloftheforeignbody,RemovaloftheforeignbodyRemovalthroughabronchoscope.Removalbythoracotomy.Tracheostomy.,Treatment,Treatment,Removalthroughbronchoscope,TracheostomyTracheostomymaybene