婴幼儿吸气性喉喘鸣病因分析与治疗

Etiology and treatment of inspiratory laryngeal stridor in infants

目的分析婴幼儿吸气性喉喘鸣的发病原因,探讨其有效治疗方法。方法回顾性分析2009年7月至2012年7月于我科就诊的256例吸气性喉喘鸣患儿的临床资料。结果 256例中,162例(63.3%)为先天性喉气道结构异常,50例(19.5%)为占位性病变,11例(4.3%11/256)为神经性疾病-声带麻痹,33例(12.9%33/256)为获得性病变引起的上呼吸道阻塞。结论喉软骨软化症仍是0～2岁婴儿吸气性喉喘鸣的主要病因,随着月龄增长有自愈的倾向;其他喉部病变也是吸气性喉喘鸣的重要病因。诊断需借助辅助检查,应尽早明确;针对不同病因采取不同的治疗方案。

Objective To summarize the cause of inspiratory laryngeal stridor in infants in order to make accurate diag- nosis and treatment of the disease. Methods The medical records of 256 cases of patients 1 ess than 2 years with pres- enting symptoms of stridor initially evaluated in the outpatient setting of otorhinolaryngological department from July 2009 to July 2012 were reviewed. The causes of stridor were clarified by examinations of flexible laryngoscopy in a- wake, throat three-dimensional CT （MRI）and bronchoscopy in all cases. Results 162 cases（63.3%, 162/256） were diagnosed as congenital airway abnomalities for cause of stridor including 153 （59.8%, 153/256 ）congenital laryngeal abnormalities and 9 （3.5% , 9/256）congenital tracheal abnormalities. The most congenital laryngeal anomaly was la- ryngomalacia（151, 60.0%, 151/256） . The most congenital tracheal abnormalities was tracheomalacia（7, 2.7%, 7/256）. Another 50 cases（ 19.5% , 50/256）were diagnosed as space-occupying lesions for cause of stridor. 11 cases （4.3%, 11/256 ） were diagnosed as neurological disease-vocal cord paralysis. 7 cases （2.7%, 7/256 ）were diagnosed as foreign body in airway and 26 cases （ 10.2%, 26/256） were respiratory infection. Conclusion Congenital airway strucunal abnormality is a major cause of infant laryngeal tridor. Laryngomalacia is still a major cause of infant inspira- tory stridor which is spontaneously resolved. Other throat lesions are also important and should be diagnosed and treated in time. The principle of treatment is relief of symptoms by different therapeutic protocols according to different etiolog- ical factors.