婴儿先天性心脏病手术后获得性声门下狭窄易感因素  

Predisposing factors of acquired subglottic stenosis in infants after operations for congenital heart disease

作　　者：余宇晖[1,2] 孙云霞[1,2] 何少茹[1,2] 葛平江[3,2] 梁穗新[1,2] 钟劲[1,2] 刘玉梅[1,2] 

机构地区：[1]广东省人民医院新生儿科 [2]广东省医学科学院,广州510080 [3]广东省人民医院耳鼻喉科

出　　处：《岭南心血管病杂志》2013年第5期586-589,600,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省科技计划项目(项目编号:2010B031600168)

摘　　要：目的 探讨婴儿先天性心脏病手术后获得性声门下狭窄（acquired subglottic stenosis,ASGS）的易感因素.方法 回顾性分析广东省人民医院2004年1月至2010年12月收治的通过纤维支气管镜检查诊断为先天性心脏病术后并声门下狭窄,年龄＜1岁婴儿的临床资料.结果 共42例患儿纳入研究,男27例,女15例,年龄2.0（0～11）个月,体质量4（3.0～7.0）kg.Ⅰ度ASGS 7例、Ⅱ度15例、Ⅲ度20例,无Ⅳ度患儿.所有患儿的气道问题都在本院完成从临床观察、保守疗法和（或）气管扩张术的治疗,40例完成随访,均治愈,2例失访,随访时间21（2～84）个月.所有患儿均有接受先天性心脏病外科手术麻醉气管插管的病史.其中0～1个月、2～6个月及7～11个月婴儿在本院小儿心外手术麻醉后的ASGS发生率分别为3.12％ （20/642）、1.25％（18/1445）及0.25％（4/1573）.气管内置管时间为（6.44±0.71）d,在＜1岁心脏手术后患儿中,置管时间≥4d的ASGS的发生率为4.07％ （31/761）,较置管时间24～96 h及＜24 h的1.42％（8/564）及0.13％（3/2335）明显增加,差异有统计学意义（P＜0.05）.合并感染31例,置管＜4 d（11例）和≥4d（31例）患儿的感染发生率分别为27.27％（3/11）及90.32％（28/31）,两组比较,差异有统计学意义有（P＜0.05）；气管插管内径为（4.14±0.35）mm;有反复气管插管史患儿占50.0％（21例）.结论 先天性心脏病心外手术时麻醉气管插管损伤是本组ASGS的最重要的原因,年龄越小发生率越高,年龄、气管内置管时间、管径大小、感染及插管次数可能是ASGS的危险因素.本组患儿预后良好.Objectives To investigate the predisposing factors of acquired subglottic stenosis （ASGS）in infants after operations for congenital heart disease.Methods We retrospectively reviewed the clinical data of infants （aged〈 1 year） who were diagnosed as ASGS by fiberoptic bronchoscopy after operations for congenital heart disease in Guangdong General Hospital from January 2004 to December 2010.Results Totally 42 cases were involved,including 27 males and 15 females [median age：2.0 （0-11） months,median weight：4 （3.0-7.0） kg].There were 7 infants with grade Ⅰ ASGS,15 with grade Ⅱ ASGS and 20 with grade Ⅲ ASGS,no grade Ⅳ ASGS cases.All theses infants completed observation,conservative treatment and （or） tracheal dilation in our hospital.Forty follow-up infants were in good respiratory status and 2 cases were lost to follow-up [median follow-up duration：21 （2-84） months].All these infants had congenital heart disease and underwent anesthesia intubation for cardiac surgery.The incidence rates of ASGS in infants of 0-1 month,2-6 months and 7-11 months after cardiac operation were 3.12% （20/642）,1.25% （18/1445） and 0.25% （4/1573） respectively.Intubated duration was （6.44±0.71） d,internal diameter of intubated tube was （4.14±0.35） mm.Twenty-one cases were with repeated intubation,31 patients complicated with infections.ASGS incidence rate of infants less than one year old after cardiac operation with intubated duration over 4 days was 4.07% （31/761）,while they were 1.42% （8/564） and 0.13% （3/2335） respectively in the cases whose intubated duration were 24-96 hours and less than 24 hours.The incidence rates of infection were 27.27% （3/11）and 90.32% （28/31） respectively in cases with intubated duration less than 4 days （11 infants） and longer than 4 day （31 infants）,and the difference between them was significant（P〈0.05）.Conclusions Intubation injury caused by anesthesia for cardiac surgery is the most important reason of ASGS in our

关 键 词：心脏缺损 先天性 声门下狭窄 易感因素 婴儿 

分 类 号：R541.1[医药卫生—心血管疾病]