NICU气管切开患儿的住院结局及随访研究  

Outcomes and post-discharge follow-up of neonatal tracheotomy in NICU

作　　者：靳绯 郁洁 翁景文 彭亚光[2] 周婧婧 陈岩 张杰[3] 黑明燕 Jin Fei;Yu Jie;Weng Jingwen;Peng Yaguang;Zhou Jingjing;Chen Yan;Zhang Jie;Hei Mingyan(Department of Neonatology,Neonatal Center,National Center for Children′s Health,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;Center for Clinical Epidemiology and Evidence-based Medicine,National Center for Children′s Health,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;Department of Otorhinolaryngology,National Center for Children′s Health,Beijing Children′s Hospital,Capital Medical University,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,100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院临床流行病学与循证医学中心,100045 [3]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,100045

出　　处：《中国小儿急救医学》2023年第3期194-198,共5页Chinese Pediatric Emergency Medicine

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：目的探讨新生儿重症监护病房(NICU)实施新生儿气管切开术(以下简称气切术)的住院结局及随访情况。方法纳入2016年1月1日至2021年8月31日在北京儿童医院NICU住院,初始入院日龄<28 d或纠正年龄不超过44周,有气切术指征的患儿。根据是否实施气切术分为气切组和非气切组(家长签字拒绝气切术)。收集患儿的一般人口学数据、住院及诊断信息、手术指征、出院后3/6/12月龄时遵医嘱随访和随访结局,并进行分析。结果共纳入26例患儿,气切组和非气切组患儿分别为14例和12例,胎龄分别为(37.7±3.80)周和(38.99±1.83)周,出生体重分别为(2823.57±948.89)g和(3320.83±378.76)g,两组间性别、胎龄、出生体重、入院日龄、入院时体重、确诊日龄、入院时气管插管呼吸支持比例的差异均无统计学意义(P>0.05)。气切组患儿的最常见手术指征为双侧声带麻痹(50.0%)和咽喉部先天结构畸形(21.4%),非气切组患儿的最常见手术指征为双侧声带麻痹(50.0%)和声门/声门下肿物(25.0%),两组间差异无统计学意义(P>0.05)。气切组和非气切组患儿的提前出院率分别为7.14%和66.67%(P=0.003),气切组与非气切组的总随访率分别为88.9%和38.9%,两组在3月龄、6月龄、12月龄时的随访率分别为100.0%比50.0%、83.3%比41.7%、81.8%比25.0%,差异均有统计学意义(P<0.05)。14例气切组患儿死亡3例,4例成功拔除气管套管,5例仍未拔除气管套管,失访2例。结论双侧声带麻痹是NICU新生儿气切术最常见的手术指征,气切组家长的依从性明显高于非气切组,气切术后对家长进行看护技能的培训有助于改善患儿总体预后。Objective To study the outcomes and post-discharge follow-up of neonatal tracheotomy in neonatal intensive care unit(NICU).Methods This study included patients who were admitted to NICU in Beijing Children′s Hospital from January,2016 to August,2021,and less than 28 days or 44 weeks(corrected age)on admission,and required tracheotomy.The patients were divided into tracheotomy group and the non-tracheotomy group(the parents signed to refuse the tracheotomy)according to whether perform tracheotomy.Demographic data,general hospitalization information,diagnosis,indications for tracheotomy,follow-up outcomes at 3/6/12 months of age after discharge of patients were collected and analyzed.Results Totally 26 patients were included in this study,14 cases in tracheotomy group and 12 cases in non-tracheotomy group.The average gestational age was(37.7±3.80)weeks and(38.99±1.83)weeks,and birth weight was(2823.57±948.89)g and(3320.83±378.76)g,respectively.There were no significant differences in sex,gestational age,birth weight,age on admission,weight on admission,age at diagnosis,ratio of endotracheal intubation for respiratory support on admission between two groups(P>0.05).The commonest indications of tracheotomy group were bilateral vocal cord paralysis(50.0%)and congenital anomaly/defect of throat/larynx(21.4%),and the commonest indications of non-tracheotomy group were bilateral vocal cord paralysis(50.0%)and vocal cord/subglottic mass(25.0%),and there was no significant difference between two groups(P>0.05).The rate of discharge-against-medical order of tracheotomy and non-tracheotomy group was 7.14%and 66.67%(P=0.003),respectively.The total follow-up rate of tracheotomy and non-tracheotomy group was 88.9%and 38.9%,while the follow-up rates at 3 months,6 months,and 12 months were 100.0%vs.50.0%,83.3%vs.41.7%,and 81.8%vs.25.0%,respectively,whose differences were statistically significant(all P<0.05).In the 14 cases of tracheotomy group,3 cases died,4 cases successfully removed the tracheal cannula,5 cases did not r

关 键 词：新生儿 新生儿重症监护病房 气管切开术 手术指征 随访率 

分 类 号：R726.5[医药卫生—儿科]