支气管镜下球囊扩张治疗不同间期对儿童气管插管致声门下狭窄的疗效观察  

Effect of bronchoscopic balloon dilation with different intervals in treatment of children with subglottic stenosis caused by tracheal intubation

作　　者：崔利丹 高刘炯 李聪慧[1] 苏军[1] 金志鹏[1] 李峥[2] CUI Lidan;GAO Liujiong;LI Conghui;SU Jun;JIN Zhipeng;LI Zheng(Pediatric Intensive Care Unit,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou,Henan,450018;Intensive Care Unit,National Center for Children′s Health,Beijing Children′s Hospital Affiliated to Capital Medical University,Beijing,100045)

机构地区：[1]郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院PICU,河南郑州450018 [2]国家儿童医学中心/首都医科大学附属北京儿童医院重症医学科,北京100045

出　　处：《实用临床医药杂志》2024年第14期82-86,共5页Journal of Clinical Medicine in Practice

基　　金：2021年度河南省医学科技攻关计划联合共建项目(LHGJ20210682)。

摘　　要：目的探讨支气管镜下球囊扩张治疗不同间期对儿童气管插管致声门下狭窄的疗效。方法选取气管插管致声门下瘢痕性狭窄患儿为研究对象,36例单纯球囊扩张治疗患儿中,观察组20例,对照组16例。观察组于第1次球囊扩张术后3 d,行电子支气管镜评估,狭窄2级以上的,进行第2次球囊扩张治疗。后续治疗原则依据:较前1次有明显回缩,狭窄2级以上的,间隔3 d再次球囊扩张治疗;无明显回缩的,间隔2周再次评估,直至连续3次共6周,内镜下狭窄部位无明显回缩,狭窄程度<25%,停止电子支气管镜评估。对照组于第1次球囊扩张之后的7 d,行电子支气管镜评估,狭窄2级以上的,进行第2次球囊扩张治疗。后续治疗原则依据:较前1次有明显回缩,狭窄2级以上的,间隔7 d再次球囊扩张治疗;无明显回缩的评估方法同观察组。后续临床随访最短6个月,最长9个月。结果2组患儿治疗总次数和转归比较,差异无统计学意义(P>0.05);观察组的治疗时间较对照组缩短,差异有统计学意义(P<0.05)。2组患儿术中并发症如出血、血氧饱和度下降、心率下降、麻醉中血压下降比较,差异无统计学意义(P>0.05)。2组患儿术后发热、喉鸣加重、呼吸困难比较,差异无统计学意义(P>0.05)。2组患儿呼吸困难、活动耐受性及需要长期氧疗比较,差异无统计学意义(P>0.05)。结论大部分气管插管导致的儿童声门下瘢痕性狭窄通过单纯球囊扩张治疗中长期效果较好,缩短单纯球囊扩张间期至3 d缩短了治疗总时间,可减轻家长的心理负担时间,但不增加家长的经济负担。术中及术后的并发症、转归及远期随访均与原来采用的间隔5~7 d无显著差别。Objective To investigate the effect of bronchoscopic balloon dilation treatment of different intervals on the tracheal intubation-induced subglottic stenosis in children.Methods Children with tracheal intubation-induced subglottic cicatricial stenosis were selected as the research objects.Among the 36 children with pure balloon dilation treatment,20 cases were enrolled in the observation group and 16 cases were enrolled in the control group.In the observation group,electronic bronchoscopy was performed at 3 days after the first-time balloon dilation treatment,and those with grade 2 or higher stenosis received the second-time balloon dilation treatment.The follow-up treatment principle was as follows.If there was obvious retraction compared with the previous time and the stenosis was grade 2 or higher,the balloon dilation treatment would be performed again after an interval of 3 days;if there was no obvious retraction,the evaluation would be performed again after an interval of 2 weeks until there was no obvious retraction in the stenosis site under endoscopy for 3 times in 6 consecutive weeks,and the degree of stenosis was less than 25%,and then the electronic bronchoscopy evaluation would be stopped.In the control group,electronic bronchoscopy was performed 7 days after the first-time balloon dilation treatment,and those with grade 2 or higher stenosis received the second-time balloon dilation treatment.The follow-up treatment principle was as follows.If there was obvious retraction compared with the previous time and the stenosis was grade 2 or higher,the balloon dilation treatment would be performed again after an interval of 7 days;the evaluation method for those without obvious retraction was the same as the observation group.The follow-up duration ranged from 6 to 9 months.Results There was no significant difference in the total number of treatments and outcomes between the two groups(P>0.05).The treatment duration of the observation group was significantly shorter than that of the control group(P<0.05).The

关 键 词：气管插管 声门下狭窄 球囊扩张 儿童 间隔时间 

分 类 号：R722[医药卫生—儿科] R562[医药卫生—临床医学] R473.72