CAJ | 학술논문

目的评价纤维支气管镜(简称纤支镜)在先天性大血管病变合并气道狭窄中的诊断价值及安全性.方法回顾性分析2005年10月至2009年6月NICU收治的经纤支镜检查确诊气道狭窄的先天性大血管病变患儿34例,其中血管环10例,主动脉梗阻性病变24例,年龄6 d～11个月,体重2.2～8.7 kg[(4.6±1.4)kg];记录纤支镜发现的气道狭窄情况、CT及手术所见确诊的心血管畸形及气道狭窄情况,总结分析纤支镜检查发现的气道狭窄与心血管畸形的关系、气道狭窄的处理及转归.结果所有病例均在NICU或手术过程中顺利完成纤支镜检查.(1)34例气道狭窄的首发症状为气促、喘鸣、反复肺部感染和呼吸机依赖.(2)10例血管环患儿均先经纤支镜检查,发现气道外压性狭窄,提示血管环,气道狭窄以气管下段为主;9例经CT、1例经手术证实为血管环,其中7例伴先天性气管狭窄.(3)24例主动脉病变中5例为术前CT提示气管狭窄,其中1例纤支镜提示气道狭窄,余19例在主动脉梗阻性畸形矫治术中、术后经纤支镜发现气道压迫狭窄.24例主动脉病变中21例有左主支气管狭窄,2例有先天性气管狭窄.纤支镜检查与CT检查对气管狭窄的诊断基本吻合.(4)34例纤支镜检查过程中2例出现一过性血氧饱和度下降,5例出现一过性心动过速,其余患儿无不良反应.结论纤支镜检查在大血管畸形伴气道狭窄的诊断中起重要作用,具有准确、安全、方便、快捷的优点,但对气管狭窄的情况、气管周围结构和血管畸形的了解需结合CT检查.
목적 평개섬유지기관경(간칭섬지경)재선천성대혈관병변합병기도협착중적진단개치급안전성.방법회고성분석2005년10월지2009년6월NICU수치적경섬지경검사학진기도협착적선천성대혈관병변환인34례,기중혈관배10례,주동맥경조성병변24례,년령6 d～11개월,체중2.2～8.7 kg[(4.6±1.4)kg];기록섬지경발현적기도협착정황、CT급수술소견학진적심혈관기형급기도협착정황,총결분석섬지경검사발현적기도협착여심혈관기형적관계、기도협착적처리급전귀.결과 소유병례균재NICU혹수술과정중순리완성섬지경검사.(1)34례기도협착적수발증상위기촉、천명、반복폐부감염화호흡궤의뢰.(2)10례혈관배환인균선경섬지경검사,발현기도외압성협착,제시혈관배,기도협착이기관하단위주;9례경CT、1례경수술증실위혈관배,기중7례반선천성기관협착.(3)24례주동맥병변중5례위술전CT제시기관협착,기중1례섬지경제시기도협착,여19례재주동맥경조성기형교치술중、술후경섬지경발현기도압박협착.24례주동맥병변중21례유좌주지기관협착,2례유선천성기관협착.섬지경검사여CT검사대기관협착적진단기본문합.(4)34례섬지경검사과정중2례출현일과성혈양포화도하강,5례출현일과성심동과속,기여환인무불량반응.결론 섬지경검사재대혈관기형반기도협착적진단중기중요작용,구유준학、안전、방편、쾌첩적우점,단대기관협착적정황、기관주위결구화혈관기형적료해수결합CT검사.
Objective To evaluate the diagnostic value and safety of flexible broachoscopy in congenital great vessel diseases complicated with airway compression. Method The medical records of patients with great vessels abnormalities who were admitted to the neonatal intensive care unit (NICU) from October 2005 to June 2009 were retrospectively reviewed; 34 cases were diagnosed as airway compression by flexible bronchoseopy, 10 cases as vascular ring, 24 cases as aortal arch obstruction. The age of the patients was 6 d-11 m, body weight 2.2-8.7 kgE (4.6±1.4) kg]. Recorded airway abnormalities detected by bronchonscopy and CT, cardiac vaseular defects and airway compression were consistent with the findings on operation. The relation between the airway compression and cardiac vascular abnormalities, treatment of the airway compression and outcome were analysed. Result Bronchoscopic assessment was successfully performed in NICU or operating room for all the patients. (1) Initial presentation of the 34 cases were tachypnea, stridor, refractory lung infection and prolonged mechanical ventilation. (2) Extrinsic compression was found in all the 10 cases with vascular ring by bronchoscopy initially which indicated vascular ring, airway compression was mainly of lower part of trachea. Diagnosis of 9 cases was consistent with CT diagnosis and in 1 case the diagnosis was confirmed by surgery; among these cases, 7 had congenital tracheal stenosis. (3) In the 24 cases with aortic obstructive lesion, 5 were detected to have tracheal stenosis by CT before correction of vascular abnormality, among whom one case was indicated to have tracheal stenosis by bronchoscopy, the other 19 cases were found with airway compression by bronchoscopy during or after vascular correction. Among the 24 cases, 21 had left main bronchial stenosis, 2 had congenital tracheal stenosis. Airway compression diagnosed by bronchoscopy agreed with the findings of CT. Two casesdeveloped transient decrease of oxygen saturation, 5 cases developed transient tachycardia. Conclusion Flexible bronchoscopy plays an important role in assessment of the airway compression complicated with great vessel abnormalities. Bronchoscopy is an accurate, convenient, safe and rapid way for airway assessment, but further examination of the peripheral structure and vascular malformation need combined examination with CT.