Shi Jingtian,He Lunde,Chen Tianfeng.Diagnosis and treatment strategy for infantile congenital heart disease complicated with tracheal stenosis in primary care institutions[J].Journal of Clinical Pediatric Surgery,2019,18(05):419-423.[doi:10.3969/j.issn.1671-6353.2019.05.016]
婴幼儿先天性心脏病合并气管狭窄的基层诊治策略
- Title:
- Diagnosis and treatment strategy for infantile congenital heart disease complicated with tracheal stenosis in primary care institutions
- Keywords:
- Heart Diseases/CN; Heart Diseases/CO; Tracheal Stenosis/DI; Tracheal Stenosis/TH; Infant; Child
- 分类号:
- R729;R541.1;R562.1+2
- 摘要:
- 目的 初步探讨婴幼儿先天性心脏病合并气管狭窄的基层诊治策略。方法 回顾性分析泉州市儿童医院2014年5月至2015年11月间收治的25例先天性心脏病合并气管狭窄患儿的临床资料，对先天性心脏病并发或合并分支支气管轻中度狭窄的患儿采用术后早期拔管策略，合并严重气管狭窄的患儿建议转入上级医院接受进一步治疗，并对治疗结局进行评估。结果 18例合并轻中度气管狭窄的简单型先天性心脏病（室间隔缺损，房间隔缺损或动脉导管未闭等）患儿在我院接受先天性心脏病手术，术后均顺利撤离呼吸机；7例先天性心脏病合并严重气管狭窄的患儿未在我院接受治疗，其中2例转入上级医院接受先天性心脏病联合气管狭窄手术，3例未及时接受手术而死亡。结论 对于绝大多数合并节段性轻中度气道狭窄的简单型先天性心脏病婴幼儿，可采取保守治疗策略；而对于合并较为严重气管狭窄的患儿，在基层医院接受手术治疗存在较大风险，应尽早转上级医院接受心脏手术等一系列外科治疗。
- Abstract:
- Objective To explore the diagnostic and therapeutic strategies of congenital heart disease (CHD) complicated with tracheal stenosis at primary hospitals.Methods Retrospective analysis was performed for medical records of 25 CHD children with tracheal stenosis from May 2014 to November 2015.For CHD children complicated with mild-moderate bronchial stenosis,operation was performed only for CHD and early postoperative extubation strategy was implemented.And CHD cases complicated with severe tracheal stenosis were referred to superior hospitals for further treatments. Results Eighteen children of simple CHD complicated with mild/moderate tracheal stenosis (ventricular septal defect,atrial septal defect or patent ductus arterious,etc.) were operated and later ventilator was successfully removed (n=7).Two surgical cases of CHD complicated with severe tracheal stenosis were referred to superior hospitals.Three patients died without surgery.Conclusion A vast majority of infants with simple CHD complicated with tracheal stenosis may be managed conservatively.For infants with severe tracheal stenosis,surgery is rather dangerous at grass-root hospitals and should be transferred to higher level hospitals for tracheal stenting and surgery.
参考文献/References:
1 焦安夏,饶小春,马渝燕,等.儿童良性中央气道狭窄133例病因分析[J].山西医科大学学报,2010,41(6):559-562.DOI:10.3969/J.ISSN.1007-6611.2010.06.028.Jiao AX,Rao XC,Ma YY,et al.Etiological analysis of 133 cases of benign central airway in children[J].Journal of Guangxi Medical University,2010,41(6):559-562.DOI:10.3969/J.ISSN.1007-6611.2010.06.028.
2 JHANG WK,PARK JJ.Perioperative evaluation of airways in patients with arch obstruction and intracardiac defects[J].Ann Thorac Surg,2008,85(12):1753-1758.
3 王荣品,梁长虹,黄美萍等.儿童先天性心脏病伴气管支气管狭窄的多层螺旋CT诊断[J].中华放射学杂志,2010,44(8):811-815.DOI:10.3760/cma.j.issn.1005-1201.2010.08.006.Wang RP,Liang CH,Huang MP,et al.Multi-slice spiral CT diagnosis of congenital heart disease of children with bronchial stenosis[J].Chinese Journal of radiology,2010,44(8):811-815.DOI:10.3760/cma.j.issn.1005-1201.2010.08.006.
4 李建斌,陈欣欣,崔彦芹等.先天性心脏病合并气道畸形的筛查结果[J].中华胸心血管外科杂志,2014,30(8):460-462.DOI:10.3760/cma.j.issn.0253-3006.2016.02.006.Li JB,Chen XX,Cui YQ,et al.Combination of airway deformity screening result of congenital heart disease[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2014,30(8):460-462.DOI:10.3760/cma.j.issn.0253-3006.2016.02.006.
5 史珍英,徐志伟,周燕萍等.先天性心脏病伴气管狭窄或受压的诊治探讨[J].中华小儿外科杂志,2009,30(5):276-279.DOI:10.3760/cma.j.issn.0253-3006.2009.05.003.Shi ZY,Xu ZW,Zhou YP,et al.Diagnosis and management for congenital heart defects complicated with tracheal stenosis or compression[J]..Chinese Journal of Pediatric Surgery,2009,30(5):276-279.DOI:10.3760/cma.j.issn.0253-3006.2009.05.003.
6 王旭,李守军,段雷雷等.先天性心脏病合并气管狭窄的保守治疗策略[J].中国分子心脏病学杂志,2012,12(1):12-14.DOI:10.3969/j.issn.1671-6272.2012.01.004.Wang X,Li SJ,Duan LL,et al.Conservative Management in Congenital Heart Disease Patients with Tracheal Stenosis[J].Molecular Cardiology of China,2012,12(1):12-14.DOI:10.3969/j.issn.1671-6272.2012.01.004.
相似文献/References:
[1]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[2]丁晋阳 莫绪明 顾海涛 孙剑 彭卫 戚继荣 沈立 束亚琴 钱龙宝. 延迟关胸技术在婴儿复杂危重先心病手术中的应用[J].临床小儿外科杂志,2011,10(02):98.
DING Jin yang,MO Xu ming,GU Hai tao,et al. Delayed Sternal Closure following operations for complex and severe congenital heart disease in infant[J].Journal of Clinical Pediatric Surgery,2011,10(05):98.
[3]仇杰 费忠化 刘宏生. 婴幼儿先心病术后并发纵膈气肿临床分析[J].临床小儿外科杂志,2012,11(04):260.
[J].Journal of Clinical Pediatric Surgery,2012,11(05):260.
[4]杨丽君 林茹 叶莉芬. 小儿先天性心脏病手术中残余机血洗涤回输对凝血功能的影响[J].临床小儿外科杂志,2012,11(06):409.
[J].Journal of Clinical Pediatric Surgery,2012,11(05):409.
[5]孙剑 莫绪明 钱龙宝. 儿童先心病手术后胸骨-纵隔感染的预防和治疗[J].临床小儿外科杂志,2013,12(05):395.
[6]郭健 李晓峰 刘晖. 先心病手术后植入永久起搏器治疗房室传导阻滞[J].临床小儿外科杂志,2014,13(03):188.
[7]陈仁伟 罗金文 曾德斌. 右腋下小切口在小儿心内直视手术中的应用研究[J].临床小儿外科杂志,2014,13(03):214.
[8]沈华 宓亚平 贾兵. 小婴儿心内直视术后撤离呼吸机失败相关因素分析[J].临床小儿外科杂志,2015,14(02):117.
[9]高毅,艾宇航..小儿先心病术后机械通气时间延长的多因素分析及治疗策略[J].临床小儿外科杂志,2016,15(05):481.
[10]田慧,董丽娜,李成龙,等.AsirV联合“双低”扫描技术在儿童先天性心脏病诊断中的应用[J].临床小儿外科杂志,2016,15(05):494.
备注/Memo
收稿日期:2018-04-22。
通讯作者:施经添,Email:9803005sjt@163.com