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OBJECTIVE: To explore the clinical characteristics,diagnosis and treatment of tracheobronchial foreign body in children and analyze the risk factors for granuloma formation. METHODS: A retrospective analysis of 228 children diagnosed withtracheobronchial foreignbody was carried out,who were treated between January 2011 and December 2017,and the binary Logistic regression on risk factors of secondary airway intimal granulation after tracheobronchial foreign body was done.RESULTS: The high incidence age of tracheobronchial foreign body in children was 1～3 years old(76.3%),and the ratio of male to female was 2.3∶1. The plant foreign bodies were the main proportion(82.9%),and the foreign bodies in left lung(52.6%)was slightly higher than in the right lung(39.5%). Endotracheal granulation(74.4%),pneumonia(76.3%)and emphysema(51.3%)were the most common complications of tracheobronchial foreign body. The type and the remaining time of foreign body were the independent risk factor for the formation of endotracheal granulation(P<0.01). The longer the disease duration,the greater the risk of granulation formation(P<0.01). The ROC curve showed that the remaining time of foreign bodies could be used as a reliable indicator of endotracheal granulation,critical values of the independent correlation factor was the course of disease more than 7.5 d. All the foreign bodies in 228 cases(100%)were successfully removed by fiberoptic bronchoscopy under local anesthesia,226 cases of 1-time take-out(success rate 99.1%),and no obvious complications occurred during and after surgery. CONCLUSION: Children aged from 1 to 3 years old are the high incidence of respiratory foreign body,and plants are more common. Plant foreign body residue is prone to endotracheal granulation,and the longer thecourse,the higher risk the granulation. Avoiding feeding infants nuts,early identification and correct diagnosis,and choosing the suitable operation method is the key to preventing and treating foreign body inhalation.
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<p><b>OBJECTIVE</b>In the recent twenty years, the diaphragmatic contraction, relaxation functions and electric activity have been explored through electromyography (EMG) and transdiaphragmatic pressure (Pdi) determination. But these techniques required some complex and expensive instruments, so the diagnosis and treatment of children's diaphragmatic fatigue have not been well evaluated. The present study explored the diagnosis of children's diaphragmatic fatigue through measuring ribcage-abdomen motion and analyzed its asynchrony.</p><p><b>METHODS</b>Fifty-three children (male 37, female 16, and age rage from 1 months to 9 years) with respiratory rate > 30 breaths/min, heart rate > 110 beats/min, and respiratory dysfunction had asynchronized ribcage-abdomen motion showed by impedance respirograph (IRG). The authors observed whether ribcage-abdomen motion was synchronic and calculated M levels (staggered peak time/total duration of the breathing cycle). The ribcage and abdomen outputs were displayed on vertical (for rib cage) and horizontal (for abdomen) axes of X-Y instrument. In addition, the change of respiratory frequency and heart rate was observed and arterial blood-gas analysis was also performed.</p><p><b>RESULTS</b>(1) M levels in one-dimensional IRG were positively correlated with alpha angle in two-dimensional IRG (r = 0.956, P < 0.001). Asynchronized respiratory motions could be divided into three types. type I showed completely contra-directional movements of respiration, M levels for (48.1 +/- 4.4)%, an irregularly clockwise loop in the two dimensional IRG, and alpha angle for (138.3 +/- 15.0) degrees. In type II, one dimensional IRG showed displaced peak of the chest and abdomen motion curves, M levels were (16.5 +/- 4.7)%, two dimensional IRG was displaced in a counterclockwise direction, and alpha angle was (55.3 +/- 10.8) degrees. In type III, abdominal motion curve of one dimensional IRG had double peaks, M levels were 0, two dimensional IRG was presented as 8-shaped double circles, alpha angle was (41.3 +/- 3.8) degrees; (2) pH levels in the patients with type I and type II diaphragmatic fatigue were significantly lower, and PCO(2) levels were significantly higher than those with type III or in the normal subjects (P < 0.001 for all), but there was no statistically significant difference between type III and the normal subjects (P > 0.05); (3) Both of respiratory rate and heart rate in type I, type II and type III were higher than those in the normal subjects (all P < 0.001), and the differences among the three types were significant (P < 0.001 for all); (4) Both M levels and alpha angle were negatively correlated with pH levels (r = -0.514, P < 0.001 and r = -0.497, P < 0.001), while positively correlated with PCO(2) levels (r = 0.672, P < 0.001 and r = 0.625, P = 0.01).</p><p><b>CONCLUSIONS</b>(1) IRG can be reliably used to diagnose children's diaphragmatic fatigue. This technique is simple and easy to perform and non-invasive. It is therefore worthy of recommending for further clinical investigations. (2) According to the characteristics of IRG, diaphragmatic fatigue can be divided into three types. (3) The development of children's diaphragmatic fatigue has a series of characteristic changes. (4) To avoid the patients suffering from respiratory failure, it is the key time to adopt the policies of prevention and treatment when IRG shows signs of type III diaphragmatic fatigue.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Diaphragm , Fatigue , Classification , Diagnosis , Respiration , Respiratory Function Tests , MethodsABSTRACT
<p><b>OBJECTIVE</b>To study the effect of Shenmai injection (SMI) on diaphragmatic fatigue in children with respiratory failure.</p><p><b>METHODS</b>Thirty-five cases of children respiratory failure with diaphragmatic fatigue were divided into two groups. The control group was treated with comprehensive therapy including anti-infection, oxygen inhalation and parenteral nutrition, etc. The SMI group was treated with SMI intravenously, besides the comprehensive therapy as in the control group. Taking electrical impedance respirogram (IRG) as criterion of therapeutic effect, the effective cases after 30 min medication, time for diaphragmatic fatigue disappearance, as well as arterial blood gas analysis before and after treatment were analyzed.</p><p><b>RESULTS</b>(1) In 30 min after medication, the effective cases in the SMI group (15/18) were more than that in the control group (4/17, P < 0.01); (2) Blood pH increased and PaCO2 decreased in both groups after treatment, but the decrease of PaCO2 was more significant in the SMI group (P < 0.05); (3) Time of diaphragmatic fatigue disappearance in the SMI group was shorter than that in the control group (P < 0.01).</p><p><b>CONCLUSION</b>SMI is an effective drug for treatment of diaphragmatic fatigue in children with less adverse effect, and worthwhile for spreading in clinical practice.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Diaphragm , Drug Combinations , Drugs, Chinese Herbal , Therapeutic Uses , Injections, Intravenous , Muscle Fatigue , Phytotherapy , Respiratory Insufficiency , Drug TherapyABSTRACT
A three-dimensional biomechanical tracting appliance is introduced in the article, which is used to treat the protrusion of intervertebral disc. The appliance is light, practical, adjustable 3D biomechanic, simple and with multiple functions and convenient operation.