先天性心脏病合并气管狭窄患儿心脏病矫治术同期置入气道支架治疗效果观察  

Clinical effect of airway stenting during heart disease correction in children with congenital heart disease complicated with tracheal stenosis

作　　者：朱耀斌[1] 闫道乐 李志强[1] ZHU Yao-bin;YAN Dao-le;LI Zhi-qiang(Department of Cardiac Surgery,Beijing Children's Hospital Af filiated to Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院心外科,北京100045

出　　处：《中华实用诊断与治疗杂志》2023年第5期464-466,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：北京市自然科学基金(7152045)。

摘　　要：目的 观察6例先天性心脏病合并气管狭窄患儿心脏病矫治术同期行气道支架置入治疗的效果,探讨其安全性。方法 先天性心脏病合并气管狭窄患儿6例,年龄4~17(9.47±3.98)个月,均于先天性心脏病矫治术后同期行气道支架置入术。记录术后CICU治疗时间及呼吸机使用时间;术后1个月行常规支气管镜检查,观察气管内支架形态、位置、有无肉芽组织等;术后3个月行超声心动图检查,观察心脏病矫治术后恢复情况,行增强CT检查评估气管形态后支气管镜下取出支架。随访1年,记录患儿术后恢复情况和生存情况,观察气管发育、肺功能及反复呼吸道感染改善情况。结果 6例患儿均顺利完成心脏矫治术,气道支架均一次性放置成功,术后CICU治疗时间(6.63±4.27)d,呼吸机使用时间(42.01±38.00)h。6例患儿气道支架置入术后均发生刺激性咳嗽,给予止咳等对症治疗后缓解,呼吸困难症状消失。术后1个月,支气管镜检查提示气管内支架形态和位置正常,无肉芽组织形成。术后3个月,增强CT和支气管镜检查显示气管形态良好后顺利取出支架;超声心动图显示心功能正常,心脏结构正常,未见残余分流。随访至2019年2月,6例患儿气管发育和肺功能均正常,无死亡病例。结论 先天性心脏病合并气管狭窄患儿心脏病矫治术同期行气道支架置入术可改善肺部通气,减少呼吸道感染,术后3个月取出支架可维持气管腔开放,不影响气管生长发育。Objective To investigate the clinical effect of airway stenting during heart disease correction in children with congenital heart disease complicated with tracheal stenosis,and to investigate its safety.Methods Six children with congenital heart disease complicated with tracheal stenosis,aged 4 to 17(9.47±3.98)months,underwent congenital heart disease correction followed by tracheal stenting.The length of postoperative CICU stay and duration of ventilation were recorded.Routine bronchoscopy was performed to observe the shape,position and granulation tissue of tracheal stent 1 month after surgery.Echocardiography was done 3 months after surgery to observe the recovery after heart disease correction surgery,and enhanced CT examination was conducted to evaluate the tracheal morphology before the removal of stent by bronchoscopy.The patients were followed up for 1 year,and the recovery and survival of children,the development of the trachea,the pulmonary function,and the improvement of recurrent respiratory infections were recorded.Results The heart disease correction surgery and tracheal stent placement were successfully performed in 6 children.The length of postoperative CICU stay was(6.63±4.27)days,and the duration of ventilation was(42.01±38.00)h.Irritating cough appeared in 6 patients after tracheal stenting and got relief after symptomatic treatment,and the symptoms of breathing difficulties disappeared.One month after surgery,bronchoscopy examination showed that the shape and position of endotracheal stent were normal,with no granulation tissue formation.Three months after surgery,enhanced CT and bronchoscopy showed that the trachea was in good shape,then the stent was smoothly removed.Echocardiography showed that the cardiac function and structure were normal,with no residual shunts.The follow-up till February 2019 showed normal tracheal development and lung function in all children,and no death.Conclusions The airway stenting during cardiac surgery in patients with congenital heart disease complicated wit

关 键 词：先天性心脏病 气管狭窄 心脏病矫治术 气道支架置入 

分 类 号：R726.5[医药卫生—儿科]