儿童重症监护病房先天性心脏病围术期患儿合并气道畸形的诊治  

Diagnostic and therapeutic methods for perioperative children with congenital heart disease with airway stenosis in pediatric intensive care unit

作　　者：许煊[1] 刘玺诚[1] 李丹丹[1] 祝彬[1] 肖利军[1] 封志纯[1] 祝益民[2] 

机构地区：[1]北京军区总医院附属八一儿童医院儿童重症监护科,100700 [2]湖南省儿童医院

出　　处：《中华儿科杂志》2013年第11期842-845,共4页Chinese Journal of Pediatrics

基　　金：十二五国家科技支撑计划项目（2012BAI04B01）

摘　　要：目的 探讨儿童重症监护病房（PICU）先天性心脏病（CHD）围术期患儿合并气道畸形的诊治.方法 对2010年1月至2011年10月在八一儿童医院重症监护病房住院的100例CHD合并难以控制的肺部感染、肺不张及术后脱机失败、而临床上考虑可能存在气道畸形的患儿行支气管镜诊断；对支气管镜检查确诊有严重气道狭窄且术后不能脱机的患儿在支气管镜直视下置入带囊支架.结果 支气管镜检查发现CHD合并气道畸形73例（73％）,其中气道重度狭窄31例（31％）,中度狭窄29例（29％）,轻度狭窄13例（13％）；10例CHD患儿因伴有严重气道狭窄术后出现撤除呼吸机困难,经支气管镜下支架置入术后,其中9例成功撤机,1例因原发病合并严重脓毒症而死亡.结论 CHD合并难以控制的肺部感染、肺不张及术后脱机失败的患儿多存在气道畸形,对CHD合并严重气道狭窄致脱机失败的患儿可采用经支气管镜置入气道支架治疗.Objective To explore the diagnostic and therapeutic methods for perioperative children with congenital heart disease（CHD） with airway stenosis in pediatric intensive care unit （PICU）. Method Fiberoptic bronchoscopy was used for the diagnosis of 100 CHD cases in PICU who were clinically considered to have possible airway malformation because of complicated difficult-to-control lung infection, atelectasis and failure with the ventilator after surgery from January 2010 to October 2011. Cases who were confirmed to have severe airway stenosis by bronchoscopy and weaning from the ventilator after surgery were treated with balloon expandable stents into the desired position in the bronchoscopy. Result There were 73 cases （73%） of CHD patients with airway abnormalities, including 31 cases of severe stenosis （31%）, moderate stenosis in 29 cases （ 29% ）, mild stenosis in 13 cases （ 13% ）. Nine of the 10 children in whom the mechanical ventilation was hard to be stopped after surgery because of severe airway stenosis were weaned from mechanical ventilation successfully by fiberoptic bronchoscopy, while one case died from primary disease with severe sepsis after the placement of bronchial stents. Conclusion CHD children with diffficult- to-control lung infection, atelectasis and failure with ventilator after surgery are often complicated with airway abnormalities. The therapeutic bronchoscopy with airway stent can be used for cases with weaning from the ventilator because of severe airway stenosis.

关 键 词：支气管镜 先天性心脏病 气管狭窄 支架 

分 类 号：R726.5[医药卫生—儿科]