先天性心脏病合并气管狭窄的保守治疗策略

Conservative Management in Congenital Heart Disease Patients with Tracheal Stenosis

目的探讨先天性心脏病合并气管狭窄的保守治疗策略及可行性。方法回顾性分析阜外医院2009年1月至2011年12月间收治21例先心病合并气管狭窄的临床资料,对先心病并发上气道狭窄患儿术后采用早拔管策略;中下气道狭窄治疗上兼顾心肺功能调整及气道的管理。结果患儿年龄1～53月;体重4～14kg。术中插管困难发现18例,术后反复脱机困难发现3例。3例术后行纤维支气管镜及CT检查明确狭窄部位。除4例放弃心脏手术治疗外,合并上气道狭窄14例均治愈出院;中、下段狭窄3例中2例治愈出院,1例转外院置气管内支架。结论绝大多数先心病合并的节段性气道狭窄,实施早拔管的保守治疗策略是安全有效的;对合并长段狭窄的患儿在心、肺调整稳定后,仍反复脱机困难者应尽早考虑支架或外科治疗。

Objective The purpose of our research was to study the conservative management in congenital heart disease（CHD） patients with tracheal stenosis（CTS）. Methods We retrospectively reviewed the medical record of 21 children with CTS from Jan.2009 to Dec.201 l.Early extubation strategy were used for upper TS, whereas for the lower CTS, we should taking into account the heart-lung function and the airway management in the meantime. Results Patients age was 1 to 53 months and weight was 4 to 14kg. 18 cases were observed because of difficult intubation and 3 cases were found postoperatively because of ventilatordependent. 3 cases were diagnosed by bronehoseopy and CT scan. Except for 4 cases without heart surgery, 14 with upper CTS and 2 cases with lower CTS were all survived to discharge. Only 1 case was transferred to other hospital for stent insertion. Conclusion Conservative treatment was safe and feasible for the majority of CHD patients with CTS. But for the long segment CTS, surgery or stent were recommended for the ventilator-dependent patients.