急诊手术治疗机械通气后呼吸状态不稳定的先天性气管狭窄  

Emergency surgery for congenital tracheal stenosis with unstable respiratory status after mechanical ventilation

作　　者：冯致余[1] 马静[2] 杨彦亮 徐惠惠[1] 毕思明[1] 吕效政 王广震[1] 王卫敏 孟晨[2] Feng Zhiyu;Ma Jing;Yang Yanliang;Xu Huihui;Bi Siming;Lyu Xiaozheng;Wang Guangzhen;Wang Weiming;Meng Chen(Department of Cardiac Surgery,Affiliated Children's Hospital,Shandong University,Jinan 250022,China;Department of Respiratory Intervention,Affiliated Children's Hospital,Shandong University,Jinan 250022,China)

机构地区：[1]山东大学附属儿童医院心脏外科,济南250022 [2]山东大学附属儿童医院呼吸介入科,济南250022

出　　处：《中华小儿外科杂志》2022年第9期796-800,共5页Chinese Journal of Pediatric Surgery

基　　金：山东省科技计划项目(2015GSF118048)。

摘　　要：目的总结急诊手术治疗机械通气后呼吸状态仍不稳定的先天性气管狭窄患儿的经验和体会。方法收集2017年2月至2021年6月在山东大学附属儿童医院接受急诊手术的9例先天性气管狭窄患儿的临床资料,其中男6例,女3例;平均手术时年龄为3.3个月,平均体重为5.2 kg;完全性气管软骨环8例,软骨环缺失1例。8例患儿为机械通气后转入本院,1例为持续气道正压通气辅助通气后转入本院。1例在外院行肺动脉吊带矫治,2例在外院行Slide气管成形及肺动脉吊带矫治,术后均脱机困难。9例患儿均进行手术治疗,术后复查随访。分析患儿手术方式、术后气管插管时间、并发症、内镜介入干预和预后等情况。结果8例患儿行Slide气管成形术,1例行气管隆突重建术。患儿平均狭窄段气管长度为3.7 cm,狭窄段气管长度范围为1.0~4.2 cm;平均体外循环时间为167 min,范围为100~247 min。术后死亡2例,住院期间出现严重并发症2例,其中1例术后出现脑出血、脑积水并行脑室腹腔分流,另1例吻合口哆开。7例存活患儿的平均气管插管时间为208.4 h,范围为37.0~636.3 h。7例患儿平均随访时间为17个月,范围为9~36个月,无出院死亡,无明显呼吸道症状。Logistic多元回归分析结果显示年龄越小的患儿更倾向于急诊手术(P=0.009,OR=0.274,95%CI为0.103~0.727)。结论急诊手术是治疗机械通气后呼吸状态仍不稳定的先天性气管狭窄患儿的有效方法。低龄是先天性气管狭窄患儿需急诊手术的危险因素,建议诊断明确后密切关注患儿病情变化,症状严重者应及时手术治疗。Objective To summarize the experiences of emergency surgery in the treatment of congenital tracheal stenosis(CTS)in children with unstable respiratory status after mechanical ventilation.Methods From February 2017 to June 2021,clinical data were reviewed for 9 CTS children undergoing emergency surgery.There were 6 boys and 3 girls with a mean operative age of 3.3 months and a mean body weight of 5.2 kg.There were complete tracheal cartilage ring(n=8)and cartilage ring loss(n=1).Eight children were transferred into our hospital after mechanical ventilation while another was transferred after continuous positive airway pressure assisted ventilation.At another hospital,pulmonary artery sling correction(n=1)and tracheoplasty plus pulmonary artery sling correction with difficult postoperative weaning(n=2)were performed.Surgical approaches,postoperative tracheal intubation time,complications,endoscopic intervention and prognosis were analyzed.Results Slide tracheoplasty(n=8)and tracheal carina reconstruction(n=1)were performed.The mean tracheal length of stenotic segment was 3.7(1.0-4.2)cm,and the mean cardiopulmonary bypass time was 167(100-247)min.There were postoperative mortality(n=2)and serious in-hospital complications(n=2),including postoperative cerebral hemorrhage&hydrocephalus with ventriculoperitoneal shun(n=1)and anastomotic dehiscence(n=1).The mean tracheal intubation time of 7 survivors was 208.4(37.0-636.3)h.During an average follow-up period of 17(9-36)months,there was no discharge death or obvious respiratory symptoms.Logistic multiple regression analysis indicated that younger children were more prone to emergency surgery(P=0.009,OR=0.274,95%confidence interval 0.103 to 0.727).Conclusions Emergency surgery is effective for CTS children with unstable respiratory status after mechanical ventilation.Young age is a risk factor for emergency surgery.Clinicians should pay close attention to status changes after a definite diagnosis.Timely surgery is indicated for severe cases.

关 键 词：气管狭窄 先天性 气管成形术 机械通气 手术治疗 

分 类 号：R726.5[医药卫生—儿科]