中国循证儿科杂志
中國循證兒科雜誌
중국순증인과잡지
CHINESE JOURNAL OF EVIDENCE-BASED PEDIATRICS
2014年
5期
365-370
,共6页
符跃强%刘成军%陈应富%李静%胡兰%许峰%冯川
符躍彊%劉成軍%陳應富%李靜%鬍蘭%許峰%馮川
부약강%류성군%진응부%리정%호란%허봉%풍천
肺动脉吊带%气管狭窄%婴幼儿
肺動脈弔帶%氣管狹窄%嬰幼兒
폐동맥조대%기관협착%영유인
pulmonary artery sling%Tracheal stenosis%Infant
目的：分析婴幼儿肺动脉吊带（ pAS）的临床特征、诊断及治疗。方法回顾性分析2009年9月至2014年7月在重庆医科大学附属儿童医院诊断为pAS的病例，分析其一般情况、临床特征、影像学检查、诊断、治疗和预后。结果29例pAS患儿进入分析，男16例，女13例，诊断pAS时年龄2月龄至3.5岁，中位年龄为7月龄。25例有反复喘息症状，26例入院时肺部听诊可闻及哮鸣音。15例为单纯pAS，确诊pAS中位年龄为6月龄；余14例伴有其他心血管病变，确诊pAS的中位年龄为8月龄，与单纯pAS患儿比较差异无统计学意义（P>0.05）。26例患儿行增强CT心血管重建+气道重建明确pAS及合并先天性心脏畸形诊断，余3例心脏超声提示pAS，增强CT仅行气道重建检查；29例CT检查均提示气道狭窄，合并支气管桥7例。25例行心脏彩超检查，其中13例检查时间早于增强CT心血管重建，5例确诊为pAS。13例行纤维支气管镜检查均发现气管狭窄，其中6例存在气管软骨环。16例行手术治疗，其中12例手术成功，4例死亡。单因素分析显示，有机械通气时间>72 h、手术时年龄≤5月龄或体外循环时间>100 min等因素的pAS患儿病死率高（ P<0.05）。结论对反复喘息发作内科治疗效果不佳的婴幼儿，需警惕pAS的可能，合并心血管畸形并不能帮助早期发现pAS。增强CT心血管重建+气道重建检查可发现pAS及伴随气道畸形，有呼吸道症状者应尽早手术治疗，多数患儿的气道畸形不需手术处理。机械通气时间>72 h、手术时年龄≤5月龄或体外循环时间>100 min与pAS患儿病死率相关。
目的：分析嬰幼兒肺動脈弔帶（ pAS）的臨床特徵、診斷及治療。方法迴顧性分析2009年9月至2014年7月在重慶醫科大學附屬兒童醫院診斷為pAS的病例，分析其一般情況、臨床特徵、影像學檢查、診斷、治療和預後。結果29例pAS患兒進入分析，男16例，女13例，診斷pAS時年齡2月齡至3.5歲，中位年齡為7月齡。25例有反複喘息癥狀，26例入院時肺部聽診可聞及哮鳴音。15例為單純pAS，確診pAS中位年齡為6月齡；餘14例伴有其他心血管病變，確診pAS的中位年齡為8月齡，與單純pAS患兒比較差異無統計學意義（P>0.05）。26例患兒行增彊CT心血管重建+氣道重建明確pAS及閤併先天性心髒畸形診斷，餘3例心髒超聲提示pAS，增彊CT僅行氣道重建檢查；29例CT檢查均提示氣道狹窄，閤併支氣管橋7例。25例行心髒綵超檢查，其中13例檢查時間早于增彊CT心血管重建，5例確診為pAS。13例行纖維支氣管鏡檢查均髮現氣管狹窄，其中6例存在氣管軟骨環。16例行手術治療，其中12例手術成功，4例死亡。單因素分析顯示，有機械通氣時間>72 h、手術時年齡≤5月齡或體外循環時間>100 min等因素的pAS患兒病死率高（ P<0.05）。結論對反複喘息髮作內科治療效果不佳的嬰幼兒，需警惕pAS的可能，閤併心血管畸形併不能幫助早期髮現pAS。增彊CT心血管重建+氣道重建檢查可髮現pAS及伴隨氣道畸形，有呼吸道癥狀者應儘早手術治療，多數患兒的氣道畸形不需手術處理。機械通氣時間>72 h、手術時年齡≤5月齡或體外循環時間>100 min與pAS患兒病死率相關。
목적：분석영유인폐동맥조대（ pAS）적림상특정、진단급치료。방법회고성분석2009년9월지2014년7월재중경의과대학부속인동의원진단위pAS적병례，분석기일반정황、림상특정、영상학검사、진단、치료화예후。결과29례pAS환인진입분석，남16례，녀13례，진단pAS시년령2월령지3.5세，중위년령위7월령。25례유반복천식증상，26례입원시폐부은진가문급효명음。15례위단순pAS，학진pAS중위년령위6월령；여14례반유기타심혈관병변，학진pAS적중위년령위8월령，여단순pAS환인비교차이무통계학의의（P>0.05）。26례환인행증강CT심혈관중건+기도중건명학pAS급합병선천성심장기형진단，여3례심장초성제시pAS，증강CT부행기도중건검사；29례CT검사균제시기도협착，합병지기관교7례。25례행심장채초검사，기중13례검사시간조우증강CT심혈관중건，5례학진위pAS。13례행섬유지기관경검사균발현기관협착，기중6례존재기관연골배。16례행수술치료，기중12례수술성공，4례사망。단인소분석현시，유궤계통기시간>72 h、수술시년령≤5월령혹체외순배시간>100 min등인소적pAS환인병사솔고（ P<0.05）。결론대반복천식발작내과치료효과불가적영유인，수경척pAS적가능，합병심혈관기형병불능방조조기발현pAS。증강CT심혈관중건+기도중건검사가발현pAS급반수기도기형，유호흡도증상자응진조수술치료，다수환인적기도기형불수수술처리。궤계통기시간>72 h、수술시년령≤5월령혹체외순배시간>100 min여pAS환인병사솔상관。
Objective To explore the clinical features,diagnosis and treatment of pulmonary artery sling in infants. Methods From September 2009 to July 2014,patients who were diagnosed as pulmonary artery sling at Childrenˊs Hospital of Chongqing Medical University were recruited and analyzed. The clinical data,imaging examination( X-ray,echocardiography and multi-detector computed tomography scan),bronchoscopy,treatment and surgery were retrospectively reviewed. Results Twenty-nine cases were diagnosed as pulmonary artery sling,including sixteen males and thirteen females with the age at diagnosis ranging from two to forty-two months( median age was seven months). Twenty-six cases manifested with recurrent wheezing and stridor. The chest auscultation of twenty-six patients had wheeze sound. Fifteen cases of children were with simple pulmonary artery sling and the diagnosis of pulmonary artery sling median age was 6 months,the other fourteen cases were accompanied by other cardiovascular diseases,with median age of 8 months with no statistical difference between the two groups( P > 0. 05 ). Twenty-six patients underwent multi-detector CT vascular and airway reconstruction which indentified the diagnosis of pulmonary artery sling and the combinating malformation of heart,another three patients only underwent multi-detector CT airway reconstruction. The CT results showed tracheal stenosis in all patients and found seven bridging bronchus. Twenty-five patients received echocardiography,3 of them were performed before CT scan,but only five patients were indentified with pulmonary artery sling. Thirteen patients received bronchoscopy and were found with tracheal stenosis, six of which were combined with cartilaginous rings. Sixteen patients underwent surgery,but four of them died. After operation,the respiratory symptom of twelve patients was improved. The duration of mechanical ventilation >72 hours,operation age ≤ 5 months or cardiopulmonary bypass time >100 minutes significantly influenced mortality(P<0. 05). Conclusion The infants who had respiratory symptoms such as recurrent wheezing,stridor and respiratory infection with poor effective medical treatment should be evaluated by multi-detector CT to identify pulmonary artery sling and airway abnormalities. Combined with cardiovascular abnormality could help early detection of pulmonary artery sling. patients with respiratory symptom should be treated with surgery to improve tracheal stenosis as early as possible,and a significant portion of patients may not need tracheal surgery. The duration of mechanical ventilation > 72 hours, operation age≤ 5 months or cardiopulmonary bypass time >100 minutes were significantly associated with mortality.
