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NEJM：口哨音咳嗽-病例报道

2018-08-09 xing.T MedSci原创

口哨咳嗽喘鸣
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虽然无法明确识别异物，但是在呼气末X射线照片中见空气滞留可以表明在支气管中存在吸入的异物，因为空气可以进入异物周围的支气管但不能排出。

患者为一名4岁的男孩，因持续咳嗽2天，间歇性口哨音而被送往耳鼻咽喉科门诊就诊。该患者没有上呼吸道病毒感染的病史或症状，并且感觉良好。他的父母报告说他在咳嗽开始前一直在吹口哨。

体格检查发现左侧中下肺呼气喘鸣，其余部分并不显著。胸部射线拍照显示左肺过度充气（如图A所示）。



虽然无法明确识别异物，但是在呼气末X射线照片中见空气滞留可以表明在支气管中存在吸入的异物，因为空气可以进入异物周围的支气管但不能排出。

考虑到异物留在肺部的可能性，医务人员进行了硬性支气管镜检查，取出了阻碍左段支气管的玩具口哨（如图B所示）。在取出异物后的第二天进行重复胸片显示左肺过度充气消退。这名儿童在一年的随访中表现良好。

原始出处：

Suresh C. Sharma,et al. Whistling Cough.N Engl J Med 2018; https://www.nejm.org/doi/full/10.1056/NEJMicm1716704

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    2018-08-09 哈哈869

    学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=337533, encodeId=42a933e53306, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 09 12:29:56 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337520, encodeId=e9f833e520b1, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Aug 09 11:00:25 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337513, encodeId=0e4033e513c2, content=口哨音咳嗽提示支气管异物可能，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Aug 09 10:13:21 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337511, encodeId=cbbc33e511f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Aug 09 10:06:23 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
    2018-08-09 1209e435m98(暂无昵称)

    学习了，谢谢分享

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=337533, encodeId=42a933e53306, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 09 12:29:56 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337520, encodeId=e9f833e520b1, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Aug 09 11:00:25 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337513, encodeId=0e4033e513c2, content=口哨音咳嗽提示支气管异物可能，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Aug 09 10:13:21 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337511, encodeId=cbbc33e511f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Aug 09 10:06:23 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
    2018-08-09 邓启付

    口哨音咳嗽提示支气管异物可能，学习了。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=337533, encodeId=42a933e53306, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Aug 09 12:29:56 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337520, encodeId=e9f833e520b1, content=学习了，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Aug 09 11:00:25 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337513, encodeId=0e4033e513c2, content=口哨音咳嗽提示支气管异物可能，学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Thu Aug 09 10:13:21 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337511, encodeId=cbbc33e511f1, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Aug 09 10:06:23 CST 2018, time=2018-08-09, status=1, ipAttribution=)]
    2018-08-09 zb1235672

    学习了

    0