新生儿喉喘鸣病因分析16例报告

Etiology of laryngeal stridor in neonates: analysis of 16 cases

目的总结新生儿喉喘鸣的发生原因,以减少新生儿喉喘鸣的误诊。方法分析2004年4月至2005年12月我院新生儿科住院的全部喉喘鸣患儿(16例)的临床资料。全部病例均完成了血清总钙及离子钙的测定、胸部X光片、喉部及肺部CT扫描检查,部分病例进行了喉镜检查、上消化道造影及染色体检查等。结果本组16例患儿院外均诊断为先天性单纯性喉喘鸣;入院后16例中5例(31%)经喉部CT扫描诊断为甲状舌管囊肿(其中2例经喉镜检查已疑似为本病),1例(6%)经染色体检查证实为猫叫综合征,2例(13%)依据临床症状及体征诊断为Pierre-Robin综合征,其余8例(50%)拟诊为先天性单纯性喉喘鸣;院外诊断与入院后诊断相比误诊50%;全部病例血清总钙及离子钙水平均在正常范围内;6例行上消化道造影的患儿,5例诊断为胃食管反流。结论新生儿喉喘鸣非常容易误诊,必须排除引起喉喘鸣的其他病理因素(如占位病变,先天性综合征等)方可拟诊先天性单纯性喉喘鸣;新生儿甲状舌管囊肿是新生儿喉喘鸣的常见原因之一;建议将喉镜检查作为喉喘鸣患儿的常规筛选手段,有条件者可进行喉部CT扫检查。

Objective To reduce misdiagnosis and explore etiology of laryngeal stridor in neonates. Methods Sixteen neonates with laryngeal stridor were reviewed. All the patients were examined with CT scan for larynx and lungs and some were examined with laryngoscopy. Laboratory examination and chromosome analysis were also done in all or some patients. Results All the 16 neonates were diagnosed before admission as congenital simple laryngeal stridor in other hospitals. Of the 16 neonates with laryngeal stridor, 5（31% ） had thyroglossal ductal cyst, 1 （6%） neonate with cri du chat （Sp^-） syndrome, 2 （ 13% ） neonates with Pierre-Robin syndrome and the rest 8 （ 50% ） were suspected of congenital simple laryngeal stridor. Conclusion Neonates with laryngeal stridor are easily misdiagnosed; neonatal thyroglossal duct cyst is one of common causes. The diagnosis for a congenital simple laryngeal stridor should be carefully made excluding the possibility of related diseases. The authors recommend that laryngoscopy and CT scan for larynx should be performed in the neonates with laryngeal stridor.