Foreign-body aspiration in an adult.
Foreign-body aspiration in an adult.
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成人异物吸入。
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
S. Karapolat
中科院分区：
文献类型：
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作者：
S. Karapolat
我读过库雷希和同事的手稿《成人异物吸入》，我祝贺作者成功治疗了这样一个罕见的病例。然而，我想对手稿的某些方面发表评论。
在讨论部分，引用Baharloo及其同事2的研究，指出“在成人人群中，此类误吸最常见继发于全身麻醉、镇静、中毒、癫痫发作或影响口咽的神经系统疾病期间的无意识意外摄入。”然而，上述手稿中没有包括这类信息。在这项回顾性研究中，228例成人患者进行了检查，并没有衰弱的因素诱发异物吸入遇到任何这些患者。此外，作者发现，牙科手术事故导致的异物吸入在成年人中更常见。因此，他们指出，异物吸入可能发生在没有任何诱发因素的情况下。
事实上，诱发异物误吸的因素和误吸物的类型受到地理和文化差异的影响。在世界各地，吸入性异物的类型和吸入比例根据人们的营养习惯、社会经济地位、文化和传统习俗而变化。尽管如此，在诱发因素的发生率和所期望的异物的性质方面都观察到了严重的变化。在过去十年中，我们遇到了越来越多的头巾针吸入病例。土耳其和中东地区戴头巾的妇女人数增加，导致固定头巾的别针被吸走的频率增加。在固定头巾的过程中，颈部被延长，别针被夹在嘴唇之间。言语或笑声可导致针深深吸入气管支气管系统。在土耳其进行的一项综合研究表明，最常见的异物是头巾别针，这与我们的经验一致。
许多综合性研究已经确定了成人异物吸入诱发因素的特征和比例。Limper及其同事4确定，在60例吸入异物的成人病例中，有25例发生了保护性气道机制受损。本文对47例成人非窒息性气管支气管异物患者按异物吸入时间长短分为急性、慢性、不确定和支气管结石四组。慢性组29例患者中，1例因败血症昏迷开始机械通气，另1例吸入异物后癫痫发作。在其他病例中，未确定诱发因素，如神经肌肉或吞咽障碍，或滥用酒精和/或镇静剂。赖和同事们在他们的40例病例中只确定了6例患者的诱发因素。在斯洛文尼亚Debeljak及其同事的一项研究中，对62名成年人进行了检查，发现最常见的异物是骨头碎片。这些患者均无神经系统疾病或意识丧失。在Zubairi及其同事的研究中，提出了84例成人异物吸入病例，未确定危险因素。最后，考虑到这些研究的结果，似乎许多异物吸入病例可能没有诱发因素。
I have read the manuscript “Foreign-body aspiration in an adult” by Qureshi and colleagues,1 and I congratulate the authors on their successful treatment of such a rare case. Yet, I want to remark on some aspects of the manuscript.
In the discussion section, the study by Baharloo and colleagues2 is referenced as stating, “In the adult population, such aspiration is most commonly secondary to unconscious accidental ingestion during general anesthesia, sedation, intoxication, seizures or neurologic disorders affecting the oropharynx.” However, such information is not included in the above-mentioned manuscript. In this retrospective study,2 28 adult patients were examined, and no debilitating factor predisposing to foreign-body aspiration was encountered in any of these patients. In addition, the authors found that the foreign-body aspiration resulting from dental surgery accidents is more common in adults. As a result, they indicated that foreign-body aspiration can occur in the absence of any predisposing factor.
In fact, the factors predisposing to foreign-body aspiration and the type of aspirated object are affected by geographic and cultural differences. Throughout the world, the types and aspiration ratios of aspirated foreign bodies change according to nutrition habits, socioeconomic status, culture and the traditions and customs of the people. Still, serious changes have been observed both in the incidence of predisposing factors and in the nature of foreign bodies aspired. In the last decade, we have encountered an increasing number of cases of turban pin aspiration. The increase in the number of women in Turkey and the Middle East who wear turbans increased the aspiration frequency of pins used for securing the turbans. During the fixation of the turban, the neck is extended and the pins are held between the lips. Speech or laughter can cause the deep aspiration of the pin into the tracheobronchial system. A comprehensive study carried out in Turkey showed that the most common aspired foreign body is the turban pin, which is in keeping with our experiences.3
Many comprehensive studies have determined the characteristics and ratios of predisposing factors for foreign-body aspiration in adults. Limper and colleagues4 determined that impairment of protective airway mechanisms occurred in 25 of 60 cases of adults who aspired foreign objects. Lan5 studied 47 adult patients with nonasphyxiating tracheobronchial foreign bodies and divided them into 4 groups (acute, chronic, uncertain and broncholith) according to the duration of foreign-body aspiration. Of the 29 patients in the chronic group, mechanical ventilation was started in 1 patient who was comatose due to sepsis, and another patient had a seizure after aspiring a foreign object. In the other cases, predisposing factors such as neuromuscular or swallowing disorders, or abuse of alcohol and/or sedatives were not determined. Lai and colleauges6 determined predisposing factors in only 6 patients in their series of 40 cases. In a study by Debeljak and colleagues7 in Slovenia, 62 adults were examined, and it was found that the most common foreign object aspired was pieces of bone. There were no neurologic disorders or loss of consciousness in any of these patients. In the study by Zubairi and colleauges,8 4 adult cases of foreign-body aspiration were presented and no risk factors were determined. Finally, as the results of these studies are taken into account, it seems that many cases of foreign-body aspiration may occur without predisposing factors.