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成人气道异物

Author
Wes Shepherd, MD, FCCP
Section Editors
Polly E Parsons, MD
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
李运, 主任医师

引言

异物吸入(foreign body aspiration, FBA)是一种可能危及生命的事件。可屈性支气管镜和硬质支气管镜是可疑FBA患者诊断和治疗的基本方法。虽然传统上FBA由耳鼻喉科医生和胸外科医生处理，但直径更小的可屈性支气管镜的发展扩展了呼吸科医生在FBA诊断和治疗中的作用。

本专题将总结成人FBA的评估和治疗。儿童FBA、中央型气道梗阻及硬质支气管镜的技术方面将单独讨论。 (参见“儿童气道异物”和“中央气道阻塞的诊断与处理”和“硬管支气管镜检查：气管插管技术”)

流行病学

FBA发生率儿童高于成人。来自美国国家安全委员会的数据显示，约有80%的FBA发生在15岁以下患者，其余20%发生在15岁以上患者[1]。总体而言，FBA是美国家庭和社区意外死亡的第4大原因(表 1)，2009年有超过4600例致命性FBA的报道[1]。

FBA相关死亡的高峰出现在1岁以下儿童和75岁以上老人[1-6]。对于4岁以下儿童，FBA是意外死亡的第4大原因，多项大型病例系列研究报道FBA的发生率高峰在1-2岁[3-6]。相比之下，年龄较大的儿童和年轻成人很少出现气管支气管FBA[1,2,7]。然而，在75岁以上成人中，发病率再次升高，FBA相关死亡的另一高峰为85岁[8]。

数项观察性病例系列研究报道的成人FBA发生率较低(0.66/100,000)[9-15]。一项单中心回顾性研究报道20年间进行了89例成人异物去除[14]。同样，梅奥诊所的病例系列研究显示33年间共诊断60例FBA成人患者，而中国台湾的一项单中心研究报道了15年间的43例FBA[11,13]。

                 

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Literature review current through: 2017-07 . | This topic last updated: 2016-07-14.
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References
Top
  1. National Safety Council. Report on injuries. Injury Facts. 2011 information online: www.nsc.org/library/report injury usa.htm (Accessed on January 23, 2014).
  2. Rafanan AL, Mehta AC. Adult airway foreign body removal. What's new? Clin Chest Med 2001; 22:319.
  3. Hsu Wc, Sheen Ts, Lin Cd, et al. Clinical experiences of removing foreign bodies in the airway and esophagus with a rigid endoscope: a series of 3217 cases from 1970 to 1996. Otolaryngol Head Neck Surg 2000; 122:450.
  4. Zhijun C, Fugao Z, Niankai Z, Jingjing C. Therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body. J Pediatr Surg 2008; 43:718.
  5. Saki N, Nikakhlagh S, Rahim F, Abshirini H. Foreign body aspirations in infancy: a 20-year experience. Int J Med Sci 2009; 6:322.
  6. Tang LF, Xu YC, Wang YS, et al. Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000-2008. World J Pediatr 2009; 5:191.
  7. Baharloo F, Veyckemans F, Francis C, et al. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999; 115:1357.
  8. http://www.nsc.org/safety_home/HomeandRecreationalSafety/Pages/Choking.aspx (Accessed on September 23, 2013).
  9. McGuirt WF, Holmes KD, Feehs R, Browne JD. Tracheobronchial foreign bodies. Laryngoscope 1988; 98:615.
  10. Wolkove N, Kreisman H, Cohen C, Frank H. Occult foreign-body aspiration in adults. JAMA 1982; 248:1350.
  11. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med 1990; 112:604.
  12. Lan RS. Non-asphyxiating tracheobronchial foreign bodies in adults. Eur Respir J 1994; 7:510.
  13. Chen CH, Lai CL, Tsai TT, et al. Foreign body aspiration into the lower airway in Chinese adults. Chest 1997; 112:129.
  14. Casalini AG, Majori M, Anghinolfi M, et al. Foreign body aspiration in adults and in children: advantages and consequences of a dedicated protocol in our 30-year experience. J Bronchology Interv Pulmonol 2013; 20:313.
  15. Mittleman RE, Wetli CV. The fatal cafe coronary. Foreign-body airway obstruction. JAMA 1982; 247:1285.
  16. Choroomi S, Curotta J. Foreign body aspiration and language spoken at home: 10-year review. J Laryngol Otol 2011; 125:719.
  17. Medidi S, Fountain A, Radwan M, Rumbak M. "Fishing in the trachea": a unique case of foreign body aspiration. J Bronchology Interv Pulmonol 2012; 19:168.
  18. Hamad AM, Elmistekawy EM, Ragab SM. Headscarf pin, a sharp foreign body aspiration with particular clinical characteristics. Eur Arch Otorhinolaryngol 2010; 267:1957.
  19. Weber SM, Chesnutt MS, Barton R, Cohen JI. Extraction of dental crowns from the airway: a multidisciplinary approach. Laryngoscope 2005; 115:687.
  20. Kovitz KL, Mayse ML. Foriegn body removal. In: Interventional Pulmonary Medicine, Beamis JF, Mathur P, Mehta AC (Eds), Marcel Dekker, New York 2004. p.259.
  21. Lund ME. Foreign body removal. In: Principles and Practice of Interventional Pulmonology, 2013. p.477-488.
  22. Elhassani NB. Tracheobronchial foreign bodies in the Middle East. A Baghdad study. J Thorac Cardiovasc Surg 1988; 96:621.
  23. HAUGEN RK. THE CAF'E CORONARY. SUDDEN DEATHS IN RESTAURANTS. JAMA 1963; 186:142.
  24. Eller WC, Haugen RK. Food asphyxiation--restaurant rescue. N Engl J Med 1973; 289:81.
  25. Wick R, Gilbert JD, Byard RW. Café coronary syndrome-fatal choking on food: an autopsy approach. J Clin Forensic Med 2006; 13:135.
  26. Holen S, Dickler EH. Missing teeth and dentures--killers of 2,500 annually. The dentists role in the prevention and treatment of food asphyxiation. J Dist Columbia Dent Soc 1973; 48:26.
  27. Feinberg MJ, Knebl J, Tully J, Segall L. Aspiration and the elderly. Dysphagia 1990; 5:61.
  28. Shaker R, Ren J, Zamir Z, et al. Effect of aging, position, and temperature on the threshold volume triggering pharyngeal swallows. Gastroenterology 1994; 107:396.
  29. Teramoto S, Matsuse T, Ouchi Y. Foreign body aspiration into the lower airways may not be unusual in older adults. Chest 1998; 113:1733.
  30. Mehta AC, Khemasuwan D. A foreign body of a different kind: Pill aspiration. Ann Thorac Med 2014; 9:1.
  31. Küpeli E, Khemasuwan D, Lee P, Mehta AC. "Pills" and the air passages. Chest 2013; 144:651.
  32. Kim ST, Kaisar OM, Clarke BE, et al. 'Iron lung': distinctive bronchoscopic features of acute iron tablet aspiration. Respirology 2003; 8:541.
  33. Boyd M, Chatterjee A, Chiles C, Chin R Jr. Tracheobronchial foreign body aspiration in adults. South Med J 2009; 102:171.
  34. Kiev J, Shepherd W, Moses L, Zhao X. Removal of an endobronchial bullet with flexible bronchoscopy nine years after injury. J Trauma 2008; 65:741.
  35. Mohamad I, Mohamad H, Ismail H. Bilateral pulmonary aspiration of teeth and the migration of a foreign body from one main bronchus to another. Med J Malaysia 2010; 65:309.
  36. Matsuse T, Oka T, Kida K, Fukuchi Y. Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest 1996; 110:1289.
  37. Yilmaz A, Akkaya E, Damadoglu E, Gungor S. Occult bronchial foreign body aspiration in adults: analysis of four cases. Respirology 2004; 9:561.
  38. Mehta AC, Rafanan AL. Extraction of airway foreign body in adults. J Bronchol 2001; 8:123.
  39. Asadi Gharabaghi M, Asadi Gharabaghi M, Firoozbakhsh S. Empyema caused by foreign body aspiration. BMJ Case Rep 2012; 2012.
  40. Hu M, Green R, Gungor A. Pneumomediastinum and subcutaneous emphysema from bronchial foreign body aspiration. Am J Otolaryngol 2013; 34:85.
  41. Lee P, Culver DA, Farver C, Mehta AC. Syndrome of iron pill aspiration. Chest 2002; 121:1355.
  42. Johnson DR, Yew D. Aspiration of nortriptyline. Am J Emerg Med 1994; 12:337.
  43. Kinsey CM, Folch E, Majid A, Channick CL. Evaluation and management of pill aspiration: case discussion and review of the literature. Chest 2013; 143:1791.
  44. Saliba J, Mijovic T, Daniel S, et al. Asthma: the great imitator in foreign body aspiration? J Otolaryngol Head Neck Surg 2012; 41:200.
  45. Martinot A, Closset M, Marquette CH, et al. Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration. Am J Respir Crit Care Med 1997; 155:1676.
  46. Tong B, Zhang L, Fang R, et al. 3D images based on MDCT in evaluation of patients with suspected foreign body aspiration. Eur Arch Otorhinolaryngol 2013; 270:1001.
  47. Cevizci N, Dokucu AI, Baskin D, et al. Virtual bronchoscopy as a dynamic modality in the diagnosis and treatment of suspected foreign body aspiration. Eur J Pediatr Surg 2008; 18:398.
  48. Zissin R, Shapiro-Feinberg M, Rozenman J, et al. CT findings of the chest in adults with aspirated foreign bodies. Eur Radiol 2001; 11:606.
  49. Heimlich HJ. A life-saving maneuver to prevent food-choking. JAMA 1975; 234:398.
  50. Ingalls TH. Heimlich versus a slap on the back. N Engl J Med 1979; 300:990.
  51. Skulberg A. Chest compression--an alternative to the Heimlich manoeuver? Resuscitation 1992; 24:91.
  52. Redding JS. The choking controversy: critique of evidence on the Heimlich maneuver. Crit Care Med 1979; 7:475.
  53. ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112:IV1.
  54. Duan L, Chen X, Wang H, et al. Surgical treatment of late-diagnosed bronchial foreign body aspiration: a report of 23 cases. Clin Respir J 2014; 8:269.
  55. Mayr J, Dittrich S, Triebl K. A new method for removal of metallic-ferromagnetic foreign bodies from the tracheobronchial tree. Pediatr Surg Int 1997; 12:461.
  56. Saito H, Saka H, Sakai S, Shimokata K. Removal of broken fragment of biopsy forceps with magnetic extractor. Chest 1989; 95:700.
  57. Kim IG, Brummitt WM, Humphry A, et al. Foreign body in the airway: a review of 202 cases. Laryngoscope 1973; 83:347.