先天性心脏病合并气道异常患儿的临床分析  

Clinical analysis of congenital heart disease with airway anomalies in children

作　　者：刘慧[1] 刘晓燕[1] 

机构地区：[1]重庆医科大学附属儿童医院心血管内科,儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆410014

出　　处：《中国循证儿科杂志》2015年第5期345-349,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：重庆市科委自然科学基金:CSTC;2010BB5373

摘　　要：目的探讨先天性心脏病（CHD）合并气道异常患儿的临床特征和预后。方法回顾性分析重庆医科大学附属儿童医院2012年1~12月行胸部多排螺旋CT（MDCT）＋气道重建和（或）纤维支气管镜（纤支镜）检查的住院CHD患儿的临床资料,按是否合并气道异常分为气道异常组和气道正常组,根据检查指征的不同,将气道异常组进一步分为心脏指征亚组和气道指征亚组。从病史中截取临床特征、CHD类型、气道异常类型、治疗和预后等资料,行气道正常组和异常组的比较。结果 460例CHD病例进入分析。气道异常组195例（42.4%）,男113例,中位年龄6月龄（1 d至14.5岁）;气道正常组265例,男157例,中位年龄3.9月龄（1 d至15.4岁）。1166/195例存在1种气道异常,包括：单纯气道狭窄（125例,64.1%）、单纯气管性支气管（21例,7.2%）、单纯对称性支气管（8例,4.1%）和单纯气道软化（6例,3.1%）等,29例伴2种及以上气道异常;外源性压迫所致气道狭窄占80.9%（123/152）。2不同类型CHD合并气道异常的比例：血管环为84.2%,梗阻型为51.5%,发绀型为49.1%,左向右分流型为33.8%。气道指征亚组左向右分流型的比例高于心脏指征亚组（62.4%vs 20.3%）,发绀型比例低于心脏指征亚组（12.0%vs 51.4%）。3气道异常组喘息、既往肺炎≥3次的比例显著高于气道正常组（P〈0.05）。4气道异常组均未行外科治疗,随访复查MDCT＋气道重建19例（轻度气道狭窄4例,中度气道狭窄15例）,其中气道狭窄消失6例（CHD术后均〉1年）,减轻6例（CHD术后〈1年5例）,无明显变化5例（出院〉1年,CHD均未矫治）,加重者2例。气道异常组死亡22例。结论儿童CHD合并气道异常的类型以气道狭窄最多见。对血管环和（或）反复呼吸道感染、喘息的CHD患儿应注意合并气道异常可能。大多数继发性轻中度气道狭窄在外源性压迫解除后1年以上,气道狭窄可能�Objective To investigate the prognosis and clinical features of congenital heart disease（ CHD） with airway anomalies in children. Methods Children with CHD hospitalized from Jan. 2012 to Dec. 2012 were underwent chest multidetector helical CT airway reconstruction and / or fiberobronchoscopy. Patients were divided into airway abnormal group and airway normal group,the former group was divided into airway indication subgroup and heart indication subgroup. Clinical data including clinical features,ultrasonic cardiogram, chest multidetector helical CT airway reconstruction, and fiberobronchoscopy inspection results were retrospectively analyzed. The treatment,outcome and prognosis of CHD patients with airway anomalies were evaluated. Results A total of 460 CHD cases were recruited,of them 195（ 42. 4%） cases of CHD accompanied with airway anomalies. The types of airway anomalies included airway stenosis,tracheal bronchus,symmetrical bronchus and airway malacia. Among them,airway stenosis was the most common（ 152 /195,77. 9%）,mainly resulting from extrinsic compression by vascular malformation or enlarged heart（ 80. 9%,123 /151）. The incidences of airway anomalies differed among different CHD（ vascular rings,84. 2%;outlet obstructive constipation,51. 5%; cyanotic CHD,49. 1%; left-to-right shunt,33. 8%; P0. 05）. The proportion of CHD differed from airway indication subgroup and heart indication subgroup（ P 0. 05）,the ratio of left-to-right shunt was higher in airway indication subgroup（ 62. 4% vs 20. 3%）,the ratio of cyanotic CHD was higher in heart indication subgroup（ 12. 0% vs51. 4%）. Airway abnormal group was more likely to result in wheezing and pneumonia≥3 times than airway normal group,and airway indication subgroup was more likely to result in cough,wheezing and repeated pneumonia ≥3 times than heart indication subgroup. The total mortality rate was 18. 2%（ 22 /121）. None patients in airway abnormal group underwent surgery. Nineteen cases with airway stenosis（ 4 with mi

关 键 词：先天性心脏病 儿童 气道异常 临床特征 

分 类 号：R725[医药卫生—儿科]