摘要
目的探讨支气管镜下新生儿撤机后呼吸困难的原因及对策。方法回顾性选择2018年11月至2021年8月成都市妇女儿童中心医院新生儿科收治的撤机后呼吸困难患儿为研究对象,分析其纤维支气管镜检查结果及治疗措施。结果研究期间共45例撤机后持续呼吸困难患儿行纤维支气管镜检查,其中支气管黏膜炎16例(35.6%),肺外气道梗阻29例(64.4%)。29例肺外气道梗阻患儿中,声门下狭窄15例,11例为瘢痕增生引起,4例为痰痂形成引起;单纯喉软化6例,鼻腔狭窄2例,喉蹼2例,喉头水肿、声带麻痹、声带赘生物、气道痉挛各1例。16例支气管黏膜炎患儿经气道灌洗后供氧或无创呼吸支持治愈;11例声门下增生狭窄患儿中,9例经气管导管扩管治愈,2例经内镜介入治疗治愈;1例鼻腔膜性狭窄、2例喉蹼、1例声带赘生物患儿经手术治疗均治愈;其余14例患儿经内科保守治疗后均好转/治愈出院。结论在严格把握撤机指征情况下,对撤机后存在呼吸困难的患儿,需考虑存在上气道及中心气道结构或功能异常等肺外因素引起的气道梗阻,尤其应重视插管后声门下狭窄的形成。
Objective To study the clinical application of bronchoscopy finding causes of neonatal dyspnea after withdrawal of ventilation and determining intervention strategy.Methods From November 2018 to August 2021,fiberoptic bronchoscopy results and further treatments of neonates with dyspnea after withdrawal of ventilation in our hospital were retrospectively analyzed.Results A total of 45 patients experienced dyspnea after withdrawal of ventilation,including 16 cases of bronchial mucositis(35.6%)and 29 cases of extrapulmonary airway obstruction(64.4%).The 29 extrapulmonary airway obstruction cases included 15 cases of subglottic stenosis(11 caused by hyperplastic scar and 4 caused by sputum scab),6 cases of simple laryngomalacia,2 cases of nasal stenosis,2 cases of laryngeal web,1 case of laryngeal edema,1 case of vocal cord paralysis,1 case of vocal cord excrescence and 1 case of airway spasm.16 patients with bronchial mucositis were cured after airway lavage and oxygen therapy or noninvasive respiratory support.For 11 patients of subglottic stenosis caused by hyperplastic scar,9 cases were cured using tracheal tube expansion technique and 2 cases were cured with endoscopic intervention.One patient of nasal cavity stenosis,two patients of laryngeal web and one patient of vocal cord excrescence were cured after surgical treatment.The other 14 patients were cured and discharged after conservative treatment.Conclusions For neonates with dyspnea after withdrawal of ventilation in neonatal intensive care unit(following proper withdrawal process),extrapulmonary airway obstruction should be considered,especially subglottic stenosis after intubation.
作者
李华英
闫莉
巨容
李彪
Li Huaying;Yan Li;Ju Rong;Li Biao(Department of Neonatology,Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China;Department of Respiration Center,Children's Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing 400015,China)
基金
四川省科学技术厅面上项目(2018JY0355)。
