肺动脉扩张和左房增大致婴儿气道受压的临床研究  

Study on infants bronchiostenosis compressed by secondary pulmonary arterial dilation and left-atrial enlargement

作　　者：金丹群[1] 陈雨青[1] 徐卫华[1] 杨泽玉[1] 胡克非[1] 

机构地区：[1]安徽省立儿童医院PICU,合肥230051

出　　处：《中国实用儿科杂志》2009年第11期851-854,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的研究继发于肺动脉扩张和左房增大的婴儿外压性气道狭窄的纤维支气管镜(纤支镜)和影像特征以及术后转归,提高对该解剖异常所致婴儿外压性气道狭窄的认识。方法以2004年1月至2007年12月安徽省立儿童医院收治的21例有明显肺动脉扩张和(或)左房增大的婴儿患者为研究对象,回顾分析该组气管受压患儿的纤支镜和影像特点及术后转归。结果21例患儿心脏彩超提示,19例有室间隔缺损和(或)动脉导管未闭,2例为完全性房室间隔缺损。纤支镜显示,左主支气管受压狭窄16例,左上叶支气管受压3例,右中叶支气管受压狭窄2例;其中重度狭窄9例,轻至中度狭窄12例。冠状位CT与纤支镜显示的结果一致。21例均在心脏外科接受手术治疗,9例患儿术后撤机困难,带机时间在12～28d。死亡2例。19例随访3个月至3年,其中2例死亡;余17例存活患儿呼吸道症状消失。结论先天性心脏病伴左房增大和肺动脉扩张可以引起婴儿外压性气道狭窄;纤支镜和(或)冠状位CT对此有极高的诊断价值;充分认识这种解剖异常,对心脏术后的治疗计划有很大帮助。Objective To summarize the fiberoptic bronchoscopic findings, radiographic presentations and post-operalive prognosis in infants bronchioslenosis compressed by secondary, pulmonary arterial dilation and left-atrial enlargeinent in order to know more about compressed bronchiostenosis. Methods Totally 21 infants with significantly enlarged left atria and / or puhnonary arterial dilations undergoing surgery＂ were observed in pediatric intensive care unit （PICU） from Jan.2004 to Sep.2008. The clinical manifestations, bronchoscopie findings, radiographic presentations, operative effects and post-operative follow-up were recorded and analyzed. Results Echocardiography showed 19 cases of ven- tricular septal defect （ VSD ） and / or patent ductus arteriosus （ PDA ）, with 2 complete atrioventricular canal （ CAVC ）. Fi- beroptic bronchoscopy showed 16 cases of extrinsic compression of the left main bronchus, 3 left upper bronchium and 2 right middle bronehium, of which 9 cases had severe stenosis, 12 light to moderate stenosis. Coronary CT examinations showed the same results as bronchoscopy. Surgical operations were performed in all＇of the cases. Nine cases needed mechanical ventilation for up to 12 to 28 days with repeated extubation failures, 2 deaths. Nineteen cases were followed up from 3 months to 3 years, 2 deaths, while the others were in good condition. Conclusion The congenital heart disease （CHD） with secondary pulmonary arterial dilation and left-atrial enlargement can induce extrinsic compressed bronchiostenosis. Bronchoseopy and cornorary CT examinations have great significance in the diagnosis. Being fully aware of the anatomical abnormalities is of much help for the treatment program of CHD.

关 键 词：婴儿 外压性气道狭窄 先天性心脏病 纤维支气管镜 

分 类 号：R72[医药卫生—儿科]