婴幼儿先天性心脏病合并气管狭窄的基层诊治策略

Diagnosis and treatment strategy for infantile congenital heart disease complicated with tracheal stenosis in primary care institutions

目的初步探讨婴幼儿先天性心脏病合并气管狭窄的基层诊治策略。方法回顾性分析泉州市儿童医院2014年5月至2015年11月间收治的25例先天性心脏病合并气管狭窄患儿的临床资料,对先天性心脏病并发或合并分支支气管轻中度狭窄的患儿采用术后早期拔管策略,合并严重气管狭窄的患儿建议转入上级医院接受进一步治疗,并对治疗结局进行评估。结果18例合并轻中度气管狭窄的简单型先天性心脏病(室间隔缺损,房间隔缺损或动脉导管未闭等)患儿在我院接受先天性心脏病手术,术后均顺利撤离呼吸机;7例先天性心脏病合并严重气管狭窄的患儿未在我院接受治疗,其中2例转入上级医院接受先天性心脏病联合气管狭窄手术,3例未及时接受手术而死亡。结论对于绝大多数合并节段性轻中度气道狭窄的简单型先天性心脏病婴幼儿,可采取保守治疗策略;而对于合并较为严重气管狭窄的患儿,在基层医院接受手术治疗存在较大风险,应尽早转上级医院接受心脏手术等一系列外科治疗。

Objective To explore the diagnostic and therapeutic strategies of congenital heart disease(CHD)complicated with tracheal stenosis at primary hospitals.Methods Retrospective analysis was performed for medical records of 25 CHD children with tracheal stenosis from May 2014 to November 2015.For CHD children complicated with mild-moderate bronchial stenosis,operation was performed only for CHD and early postoperative extubation strategy was implemented.And CHD cases complicated with severe tracheal stenosis were referred to superior hospitals for further treatments.Results Eighteen children of simple CHD complicated with mild/moderate tracheal stenosis(ventricular septal defect,atrial septal defect or patent ductus arterious,etc.)were operated and later ventilator was successfully removed(n=7).Two surgical cases of CHD complicated with severe tracheal stenosis were referred to superior hospitals.Three patients died without surgery.Conclusion A vast majority of infants with simple CHD complicated with tracheal stenosis may be managed conservatively.For infants with severe tracheal stenosis,surgery is rather dangerous at grass-root hospitals and should be transferred to higher level hospitals for tracheal stenting and surgery.