经转运收入院的111例上气道梗阻新生儿临床特征及诊治结局  

Clinical characteristics and outcomes of 111 neonates with upper airway obstruction admitted via transportation

作　　者：靳绯 翁景文 周婧婧 陈岩 张杰[2] 黑明燕 Jin Fei;Weng Jingwen;Zhou Jingjing;Chen Yan;Zhang Jie;Hei Mingyan(Department of Neonatology,Neonatal Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Otorhinolaryngology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院新生儿中心,北京100045 [2]国家儿童医学中心首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,北京100045

出　　处：《中华儿科杂志》2022年第2期88-93,共6页Chinese Journal of Pediatrics

基　　金：北京市医院管理中心儿科协同发展中心儿科专项创新推广项目(XTCX201816)。

摘　　要：目的总结经转运收入院的上气道梗阻(UAO)新生儿的临床特征及诊治结局,为这类患儿的临床管理提供更多循证依据。方法单中心病例总结,纳入2016年1月1日至2021年5月31日北京儿童医院新生儿中心经转运收住院、入院时<28日龄或校正年龄≤44周龄、第一诊断为UAO的病例,总结分析患儿的临床特点。根据UAO的不同部位分析病因、治疗、合并症及住院结局。采用四格表资料的χ^(2)检验比较不同部位UAO手术与非手术治疗患儿的转归。结果共纳入UAO患儿111例,占同期新生儿重症监护病房(NICU)4826例住院患儿的2.3%,其中男62例(55.9%),足月儿101例(91.0%),出生胎龄(38.7±2.0)周,出生体重(3207±585)g,入院时校正胎龄(40.8±2.5)周,入院体重(3221±478)g,其中35例患儿(31.5%)入院时已存在宫外生长发育迟缓,92例(82.9%)患儿在生后<1 d出现UAO的症状,25例(22.5%)入院前已明确UAO的具体病因诊断。最终因鼻、咽喉和颈部病变导致UAO的病例分别为24例(21.6%)、71例(64.0%)和16例(14.4%)。前5位病因分别为声带麻痹(28例)、双侧后鼻孔闭锁(20例)、咽软化(15例)、咽囊肿(7例)和声门下血管瘤(6例)。患儿入院后按“NICU-耳鼻喉-影像”多学科合作流程进行诊治,其中102例(91.9%)患儿进行了支气管纤维镜联合喉镜检查。70例(63.1%)患儿入院时需要气管插管呼吸支持。58例(52.3%)患儿实施了手术治疗,其中气管切开的患儿共16例,手术与非手术治疗患儿的治愈好转率为94.8%(55/58)比54.7%(29/53)、非医嘱离院率为1.7%(1/58)比45.3%(24/53),差异均有统计学意义(χ^(2)=24.21、30.11,均P<0.01)。结论新生儿UAO可发生于上气道不同部位,总体预后较好,多学科合作的诊治模式有助于明确梗阻部位及原因、正确评估病情和给予干预。Objectives To analyze the clinical characteristics and outcomes of neonates with upper airway obstruction(UAO)who were admitted via transportation,hence to provide more evidence-based information for the clinical management of UAO.Methods This was a single center retrospective study.Patients were hospitalized in Beijing Children′s Hospital from January 1,2016 to May 31,2021 with age<28 days or postmenstrual age(PMA)≤44 weeks,and UAO as the first diagnosis.The general information of patients,obstructed sites in the upper airway,treatment,complications and prognosis were analyzed.The outcomes of surgical UAO vs.non-surgical UAO were analyzed by 2 by 2χ^(2) test.Results A total of 111 cases were analyzed(2.3%of the total NICU hospitalized 4826 infants in the same period),in which 62(55.9%)were boys and 101(91.0%)were term infants,and their gestational age was(38.7±2.0)weeks,birth weight(3207±585)g,PMA on admission(40.8±2.5)weeks and weight on admission was(3221±478)g.There were 92 cases(82.9%)with symptoms of UAO presenting on postnatal day 1,and 35 cases(31.5%)had extra-uterine growth retardation on admission.The diagnosis of UAO and the obstructive site was confirmed in 25 cases(22.5%)before transportation.There were 24 cases(21.6%),71 cases(64.0%),and 16 cases(14.4%)who had UAO due to nasal,throat,and neck problems,respectively.The top 5 diagnosis of UAO were vocal cord paralysis(28 cases),bilateral choanal atresia(20 cases),laryngomalacia(15 cases),pharynx and larynx cysts(7 cases),and subglottic hemangioma(6 cases).The diagnosis and treatment of all the patients followed a multidisciplinary approach consisted of neonatal intensive care unit,ear-nose-throat department and medical image departments.A total of 102 cases(91.9%)underwent both bronchofiberscope and fiber nasopharyngoscope investigation.Seventy cases(63.1%)required ventilation.Among the 58 cases(52.3%)who required surgical intervention,16 had tracheotomy.For cases with vs.without surgical intervention,the rate of cure and(or)improvement were

关 键 词：婴儿 新生 诊断 气道梗阻 治疗 结局 

分 类 号：R722.1[医药卫生—儿科]