胸部CT及气道重建对发现先天性心脏病合并气道异常的意义  

Clinical Implication of the Detection of Airway Abnormalities in Children With Congenital Heart Disease by Chest CT Scan and Airway Reconstruction Method Under the COVID-19 Pneumonia Epidemic

作　　者：童峰[1] 郭张科 范凡 李晓峰[1] 郑佳[1] 李奇林[1] 李培[1] 柏松[1] TONG Feng;GUO Zhangke;FAN Fan;LI Xiaofeng;ZHENG Jia;LI Qilin;LI Pei;BAI Song(Department of Cardiac Surgery,Beijing Children’s Hospital Affiliated to Capital Medical University National Center for Children's Health,Beijing(100045),China)

机构地区：[1]首都医科大学附属北京儿童医院心外一科国家儿童医学中心,北京市100045

出　　处：《中国循环杂志》2022年第5期507-512,共6页Chinese Circulation Journal

摘　　要：目的:通过回顾性分析先天性心脏病(先心病)合并气道异常的术前筛查结果,探讨经胸部CT及气道重建检查的意义,及对合并气道狭窄的先心病患儿围术期治疗效果的影响。方法:连续入选2020年1月22日至2020年12月31日住我科的先心病患儿230例,术前全部行胸部CT及气道重建检查。其中男125例,女105例;年龄0.17~156.00(17.60±21.60)个月;体重2.2~55.0(10.1±5.7)kg。根据手术是否应用体外循环分为体外循环组(n=197)及非体外循环组(n=33)。结果:230例患儿中气管支气管畸形检出率为5.7%(13/230),气道狭窄检出率为40.0%(92/230)。体外循环组中气道异常与无气道异常患儿在年龄、体重、术前肺动脉高压程度、术前有无呼吸道和消化道症状、有无气管支气管畸形、呼吸机辅助时间、重症监护病房(ICU)滞留时间、总住院时间、体外循环和主动脉阻断时间方面的差异均有统计学意义(P均<0.05)。非体外循环组中气道异常与无气道异常患儿在术前有无呼吸道症状和消化道症状方面的差异均有统计学意义(P均<0.05)。体外循环组的患儿合并气道异常、气道狭窄部位及程度与呼吸机辅助时间、ICU滞留时间、总住院时间、体外循环和主动脉阻断时间、转归均相关;气管支气管畸形与ICU滞留时间相关。结论:先心病合并气道异常最常见的是气道狭窄,其次是气管支气管畸形等,胸部CT及气道重建可明确诊断。气道异常往往影响先心病围术期的治疗,加强术前筛查可以提高治疗效果。Objectives:During the COVID-19 pneumonia epidemic,chest CT scan has become a necessary pre-hospital screening examination.We retrospectively analyzed the prevalence of airway abnormalities during preoperative screening among children with congenital heart disease,and explored the diagnostic value of chest CT scan and airway three-dimensional(3D)reconstruction on airway abnormalities,and the impact of airway abnormalities on the perioperative results in children with congenital heart disease.Methods:A total of 230 consecutive children with congenital heart disease hospitalized in our hospital from January 22 to December 31,2020 were enrolled.All of them underwent chest CT scan and airway 3D reconstruction before surgery.Among them,there were 125 males and 105 females;the age was 0.17-156.00 months(average:[17.60±21.60]months);the weight was 2.2-55.0 kg(average:[10.1±5.7]kg).Patients were divided into airway abnormality group and normal airway group,and then divided into cardiopulmonary bypass group and non-cardiopulmonary bypass group.Results:The detection rate of tracheal bronchial malformations in the whole group was 5.7%(13/230)and airway stenosis rate was 40.0%(92/230).In the cardiopulmonary bypass group,there were statistical differences between the two groups with and without airway abnormalities in age,weight,preoperative pulmonary hypertension,preoperative respiratory symptoms,preoperative gastrointestinal symptoms,presence of tracheal bronchus,ventilator assist time,ICU length of stay,length of hospital stay,cardiopulmonary bypass time and aortic clamping time.In the non-cardiopulmonary bypass group,there were statistical differences between patients in the airway abnormality group and normal airway group in preoperative respiratory symptoms,preoperative gastrointestinal symptoms,location of airway stenosis and degree of airway stenosis before surgery.This study also found that the abnormal airway showed by CT scan,the location of airway stenosis,and the degree of airway stenosis were related to ventila

关 键 词：先天性心脏病 气道狭窄 气管支气管畸形 胸部CT 气道重建 

分 类 号：R54[医药卫生—心血管疾病]