先天性心脏病术后并发声门下狭窄治疗方法的探讨及中期随访

Treatments and outcomes of subglottic stenosis in children after surgical repairing congenital heart disease

目的探讨先天性心脏病患儿术后并发声门下狭窄（subglottic stenosis，SGS）的治疗及预后。方法回顾性分析2010年7月1日至2013年6月30日在我院行先天性心脏病手术后并发声门下狭窄的34例患儿，其中男19例，女15例，平均年龄（7．7±1．6）m，平均体质量（5．5±3．0）kg。按Cotton’s声门下狭窄分度I度5例、Ⅱ度12例、Ⅲ度17例，无Ⅳ度病例。所有病例按治疗方案不同分为两组，其中留置气管导管组8例采用SGS手术或扩张后留置气管导管〉24h、全身激素（静脉推注地塞米松0．3mg／kg，6h1次，连续3d，减量至1周停）的治疗方案，非留置气管导管组26例采用扩张后即刻拔除气管导管、全身激素（静脉推注地塞米松0．3mg／kg，6h1次，连续3d，减量至1周停）、激素雾化（持续令舒雾化1周）的治疗方案。采用7。检验对两组的再次住院比例、再狭窄率及病死率进行比较，所有数据应用SPSS16．0统计软件进行分析，以P〈0．05为差异有统计学意义。结果所有患儿均完成治疗及随访，中位随访时间15（7-40）个月，非留置组再次住院例数比例明显低于留置组（11．5％比75．0％），非留置组再狭窄率显著低于留置组（11．5％比87．5％），非留置组病死率显著低于留置组（3．8％比37．5％），三者差异均有统计学意义（P〈0．05）。结论SGS是先天性心脏病术后一种少见的并发症，早期诊断及干预可使大部分患儿取得良好的预后，扩张术后即刻拔除气管导管优于留置气管导管，此方法更简单、易行，便于在基层医院推广。

Objective To explore the treatments and outcomes of children complicated with subglottic stenosis after surgical repairing congenital heart disease （CHD）. Methods A total of 34 cases complicated with subglottic stenosis after CHD surgery from July 1, 2010 to June 30, 2013 were retrospectively analyzed. There were 19 boys and 15 girls with an average age of 7. 8 ± 1.6 months and an average weight of 5.5± 3.0 kilogram. According to the Cotton＇s subglottic stenosis grading system, the degrees were Ⅰ （n = 5）, Ⅱ （n = 12）, Ⅲ （n = 17） and Ⅳ （n = 0）. They were divided into two groups of A （intubation, n = 8） and B （non-intubation, n = 26） according to treatment plan. Group A had endotracheal intubation implanted for over 24 h after endotracheal tube dilatation or subglottic stenosis surgery. Systemic infusion of dexamethasone was used for 1 week. Group B had an immediate extubation after dilatation. Dexamethasone infusion and budesonide atomization were administered for 1 week. Chi-square or Fisher＇s exact test was used to compare the profiles of readmission, re-stenosis rate and mortality for two groups. Statistical analysis was performed with 16. 0 SPSS software. P〈0. 05 was considered statistically significant. Results All patients completed treatment. The median follow-up period was 15 months. The readmission rate（ll. 5% vs 75.0%）, re-stenosis rate （11.5% vs 87. 5G）and mortality （3.8% vs 37. 5%） of group B were significantly lower than those of group A. And the differences were statistically significant （P〈0. 05）. Conclusions Subglottic stenosis is a rare postoperative complication of congenital heart disease. Early diagnosis and proper interventions yield a good prognosis. Tracheal extubation immediately after dilatation with endotracheal tube to treat subglottic stenosis is both simple and suitable for wider popularization at primary hospitals.