新生儿阻塞性呼吸困难的病因分析及治疗

Diagnosis and treatment of neonatal inspiratory dyspnea

目的探讨新生儿阻塞性呼吸困难的病因、临床特征及治疗方法,提高新生儿阻塞性呼吸困难的诊断水平及治愈率。方法2001年3月—2004年6月深圳市儿童医院新生儿科住院的阻塞性呼吸困难的患儿共11例,男6例,女5例;出生时间为8h～28d,平均7.2d。4例发生新生儿窒息,出生后即行气管插管。3例不能发出哭声,直接喉镜检查双声带麻痹2例,多发性颅神经麻痹1例。2例饮奶不能连续,间断性呼吸困难加重,鼻部CT、MRI确诊先天性腺样体肥大、新生儿鼻炎各1例。6例持续性呼吸困难,直接喉镜检查确诊先天性会厌囊肿4例,气管镜检查确诊声门下狭窄1例,气管切开时确诊胸段气管狭窄1例。结果先天性会厌囊肿4例和先天性腺样体肥大1例,均经手术切除治愈;双声带麻痹2例和声门下狭窄1例行气管切开术,1例术后双声带活动功能恢复,拔管出院,另2例带管出院;胸段气管狭窄1例死亡,多发性颅神经麻痹1例放弃治疗。结论对新生儿阻塞性呼吸困难早期进行直接喉镜或气管镜等相关检查,及时行病因治疗,可提高诊断及治愈率。

Objective To analyze the causes and the clinical characteristics of the neonatal inspiratory dyspnea; so to raise the diagnosis and cure rate of the disease. Methods Eleven new born infants with severe inspiratory dyspnea were investigated from March, 2001 to June, 2004 in Shenzhen children＇s hospital. Six infants were male and 5 were female. The average age was 7.2 days （ range from 8 hours to 28 days）. Four cases were hospitalized with trachea intubation. Three of them can not cry,and 2 cases were diagnosed as bilateral vocal cord paralysis, 1 case as multiple cranial nerve palsy with direct laryngoscopy. Two cases couldn＇t drink milk continuously and accompanied with deteriorated inspiratory dyspnea, and were diagnosed as congenital adenoid hypertrophy and neonatal rhinitis respectively with compute tomography and magnetic resonance imaging. Among the 6 cases with persistent inspiratory dyspnea, four of them were diagnosed as congenital laryngocele by direct laryngoscope, one case was diagnosed as subglottic stenosis by tracheoscopy and one case was confirmed to be thoracic tracheostenosis when tracheotomy performed. Results Four congenital laryngoceles and one case congenital adenoid hypertrophy were cured with surgery. Two bilateral vocal cord paralysises and one case of subglottic stenosis received tracheotomy. One neonatal rhinitis case applied 0.25% ephedrine. One case of thorcal tracheostenosis died. The parents of the infant with multiple cranial nerve palsy refused to accept any treatment. Conclusions The laryngoscope examination is recommended for patients with neonatal inspiratory dyspnea. It is necessary for patients with persistent dyspnea to be examined by tracheoscopy as early as possible,