影响新生儿声带麻痹出院结局的回顾性队列研究  

Factors influencing the discharge outcomes of neonatal vocal cord paralysis:A retrospective cohort study

作　　者：陈栋[1] 李晓莺[1] 刘向红[1] 康丽丽[1] 韩玉杰 郎玉洁[1] 李云霞[1] 邓轲[1] CHEN Dong;LI Xiaoying;LIU Xianghong;KANG Lili;HAN Yujie;LANG Yujie;LI Yunxia;DENG Ke(Department of Neonatology,Children's Hospital Affiliated to Shandong University,Jinan Children's Hospital,Jinan 250022)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院),济南250022

出　　处：《中国循证儿科杂志》2023年第3期195-198,共4页Chinese Journal of Evidence Based Pediatrics

摘　　要：背景新生儿声带麻痹(VCP)的临床特点和近期预后的影响因素不确切。目的探讨新生儿VCP出院结局的影响因素。设计回顾性队列研究。方法新生儿VCP诊断根据病史、体征和支气管镜检查结果,纳入2013年4月至2022年1月在济南市儿童医院NICU确诊为新生儿VCP的病例,以出院时是否需有创通气和自行吸吮分为好转出院组和非好转出院组,采集如下临床资料用于本文单因素分析。①孕母资料:年龄、妊娠期高血压、妊娠期糖尿病、分娩方式、胎膜早破、脐带绕颈、脐带扭转、羊水情况;②新生儿资料:性别、胎龄、出生体重、1 min Apgar评分、伴发畸形、喉梗阻;③VCP病因:产伤、神经源性、医源性、特发性;④支气管镜下所见:单侧VCP和双侧VCP(完全麻痹和不全麻痹);⑤出院时预后。以单因素分析P<0.10的变量为自变量行多因素Logistics回归分析。主要结局指标影响好转出院的因素。结果133例新生儿VCP进入本文分析,首次行支气管镜检查日龄为6(4,12)d,入院日龄13.0(3.0,20.5)d,胎龄39.0(38.0,40.0)周,伴发畸形71例(53.4%,94例次),单侧VCP 43例(32.3%);双侧VCP 90例,其中不全麻痹57例,完全麻痹33例。好转出院组96例(72.2%)。非好转出院组37例,其中撤机困难28例,气管切开8例(双侧不全麻痹7例,双侧完全麻痹1例),气管切开后均成功脱离正压通气并出院,4例声带运动于9个月内恢复,4例失访;吸吮-吞咽-呼吸协调障碍37例。纳入单因素分析P<0.10的变量(剖宫产、羊水多、出生体重、低Apgar评分、神经源性损伤、喉梗阻、声带麻痹类型)行多因素Logistics回归分析,结果显示,双侧不全麻痹为新生儿VCP好转出院的不利因素(OR=6.785,95%CI:2.191~21.013,P=0.001)。结论双侧VCP、尤其是双侧声带不全麻痹新生儿的近期预后差,气管切开可以作为一种姑息治疗手段。Background The clinical characteristics of neonatal vocal cord paralysis(VCP)and the factors influencing short-term prognosis remain uncertain.ObjectiveTo investigate the factors influencing the discharge outcomes of neonatal VCP.DesignRetrospective cohort study.MethodsThe study included neonates diagnosed with VCP by medical history,clinical signs,and bronchoscopy results in the Neonatal Intensive Care Unit(NICU)of Jinan Children's Hospital between April 2013 and January 2022.The cases were divided into two groups:the improved discharge group(those who did not require invasive ventilation and were able to suckle independently at discharge)and the non-improved discharge group.The data collected for univariate analysis included maternal data of age,gestational hypertension,gestational diabetes,mode of delivery,premature rupture of membranes,nuchal cord,umbilical cord torsion,and amniotic fluid conditions;neonatal data of gender,gestational age,birth weight,1-minute Apgar score,associated malformations,and laryngeal obstruction;VCP etiology of birth injury,neurogenic,iatrogenic,and idiopathic;unilateral VCP and bilateral VCP(complete paralysis and incomplete paralysis)by bronchoscopy;and prognosis at the time of discharge.Variables with a P-value<0.10 in the univariate analysis were included as independent variables in the multivariate logistic regression analysis.Main outcome measuresFactors influencing the improved discharge.ResultsA total of 133 cases of neonatal VCP were included in the analysis.The age of the first bronchoscopy examination was 6(4,12)days,the admission age was 13.0(3.0,20.5)days,and the gestational age was 39.0(38.0,40.0)weeks.There were 71 cases(53.4%)with associated malformations,43 cases(32.3%)with unilateral VCP and 90 cases with bilateral VCP including 57 cases of incomplete paralysis and 33 cases of complete paralysis.The improved discharge group consisted of 96 cases(72.2%),while the non-improved discharge group had 37 cases,including 28 cases with difficulty weaning,8 cases with trache

关 键 词：声带麻痹 新生儿 不全麻痹 完全麻痹 临床特点 预后 

分 类 号：R722.1[医药卫生—儿科] R767.4[医药卫生—临床医学]