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摘要: 目的:探讨新生儿期上气道梗阻的诊断评估特点,对新生儿期上气道梗阻病因进行分类,建立规范诊治方案,改善患儿预后。方法:回顾性分析71例上气道梗阻患儿的临床资料,38例采用内科加外科手术联合治疗,17例单纯行内科对症支持等保守治疗,16例放弃治疗自动出院。通过纤维喉镜、CT、颈部B超、MRI等结果分析评估有效性,并对治疗预后转归进行相关分析,评价上气道梗阻相关风险因素。结果:55例治愈或好转;16例放弃治疗自动出院的患儿死亡率为81.25%(13/16)。电子鼻咽喉镜检查确定上气道梗阻平面率为100%;B超检查对于上气道囊性占位的符合率为100%。病因排序:先天性占位性病变、先天性上气道发育畸形、声带麻痹、Pierre-Robin综合征。梗阻部位对上气道梗阻的严重程度有显著影响(P<0.05)。非气管插管组的治愈率高于气管插管组(P<0.05)。结论:梗阻部位显著影响疾病的严重程度和预后。上气道占位性病变是引起新生儿上气道梗阻的首要因素。早期系统的气道评估,及时针对病因治疗,可提高治愈率,改善患儿预后。内科联合外科手术治疗对解除上气道梗阻有效。Abstract: Objective: To discuss the diagnosis and evaluation of upper airway obstruction in neonates, classify the possible causes of neonatal upper airway obstruction, establish a standardized diagnosis and treatment procedure to improve the of treatment efficacy. Method: Clinical data of 71 cases with upper airway obstruction history were retrospective analyzed, 38 cases were treated by combined medical and surgical treatment, 17 cases underwent medical treatment, 16 cases abandonment the treatment. The effectiveness of fibrolaryngoscope, CT, neck ultrasound, MRI and other results was evaluated, and to analyze the prognosis of the treatment, the outcomes and risk factors were also analysed, to evaluate risk factors associated with upper airway obstruction. Result: Fifty-five cases were cured or improved. The mortality rate of 16 children who gave up treatment and left hospital automatically was 81.25%(13/16). The accuracy rate of flexible laryngoscope in detecting the level of upper airway obstruction was 100%, the coincidence rate of B-ultrasound for upper airway cystic occupation was 100%. Etiological order from high to low was congenital space-occupying lesions, congenital upper airway malformation, vocal cord paralysis, Pierre-Robin syndrome. The site of obstruction has a significant influence on the severity of upper airway obstruction(P<0.05). The cure rate of the non-endotracheal intubation group was higher than that of the endotracheal intubation group(P<0.05).Conclusion: The obstruction site of upper airway significantly affects the outcome and the severity of the disease. Upper airway space occupying lesions are the primary causes of upper airway obstruction in neonates. Early assessment and timely treatment can improve the cure rate and improve the prognosis. Internal medicine combined with surgical treatment is effective in relieving upper airway obstruction.
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Key words:
- neonate /
- upper airway obstruction /
- prognosis
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