气管支气管软化对儿童充血型先天性心脏病纠治术后早期恢复的影响

Effect of tracheobronchomalacia on early recovery after surgical repair for congestive congenital heart disease

目的探讨气管支气管软化(TBM)对不同类型充血型先天性心脏病(CHD)患儿术后早期恢复的影响。方法回顾性分析2007年1月—2010年12月上海交通大学医学院附属上海儿童医学中心心胸外科监护室收治的所有充血型CHD术后患儿,查阅所有病例的手术资料和监护记录;按照纤维支气管镜检查结果,即是否存在中度以上气管软化或TBM,将每类疾病患儿分成TBM组和无TBM组,进行临床资料和预后的比较。结果回顾总结充血型CHD患儿共5 061例,经纤维支气管镜诊断为TBM237例,发生率为4.7%。主动脉缩窄合并室间隔缺损、永存动脉干和主动脉弓中断合并室间隔缺损患儿的TBM发生率位列前三位,分别为34.68%、29.17%和28.00%。房室间隔缺损(包括完全性和部分性)、室间隔缺损和房间隔缺损病例中,TBM组患儿月龄和体质量明显低于无TBM组(P<0.05);完全性大血管错位病例中,TBM组患儿的月龄和体质量大于无TBM组(P<0.05);在其他类型CHD患儿中,TBM组与无TBM组年龄和体质量比较,差异无统计学意义(P>0.05)。除主动脉弓中断/室间隔缺损外,对于其余类型CHD,TBM组的患儿需要较长的机械通气时间和(或)重症监护病房(ICU)滞留时间(P<0.05)。结论 TBM对充血型CHD早期恢复的影响主要表现在机械通气时间和ICU停留时间延长,尤其是低年龄、低体质量患儿;手术前应对大气道状况进行准确评估,并制定手术后机械通气策略。

Objective To investigate the effect of tracheobronchomalacia(TBM) on early recovery after surgical repair for different types of congestive congenital heart disease(CHD).Methods The clinical data of all the patients with congestive CHD hospitalized in intensive care unit of Department of Cardiovascular and Thoracic Surgery,Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University School of Medicine between January 2007 and December 2010 were retrospectively analysed.Patients of each type of congestive CHD were divided into TBM group and non-TBM group according to the findings of bronchofiberscopy,and the clinical data and outcomes were compared.Results There were 237 cases of TBM diagnosed by bronchofiberscopy in 5 061 cases of congestive CHD,with the incidence of 4.7%.Coarctation of the aorta with ventricular septal defect,persistent truncus arteriosus and interruption of aortic arch with ventricular septal defect had the higher incidences of TBM,which were 34.68%,29.17% and 28.00%,respectively.In patients with atrioventricular septal defect,ventricular septal defect and atrial septal defect,the age and body weight in TBM group were significantly lower than those in non-TBM group(P0.05).In patients with transposition of the great arteries,the age and body weight in TBM group were significantly higher than those in non-TBM group(P0.05).There was no significant difference in age and body weight between TBM group and non-TBM group in patients with the other types of CHD(P0.05).Except for the patients with interruption of aortic arch with ventricular septal defect,those in TBM group of children with the other types of CHD had prolonged time of mechanical ventilation and/or duration of intensive care unit stay(P0.05).Conclusion TBM may lead to prolonged time of mechanical ventilation and duration of ICU stay in patients with congestive CHD,especially in young infants with low body weight.Evaluation of the airway conditions before surgery and design of the postoperative mechanical ventilation management are important.