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目的探讨喉气管病变致呼吸衰竭的临床特点及诊断方法 ,以减少误诊病例。方法收集2006年7月-2009年7月于本院ICU住院行呼吸机治疗并确诊为喉气管病变15例患儿的临床资料。男11例,女4例;年龄30d～22个月。回顾分析其既往病史、临床经过及喉气管螺旋CT检查,以及部分患儿呼吸道三维重建和MRI检查。结果临床表现为出生后喉喘鸣7例,反复肺部感染6例,吃奶或哭闹后发绀5例,迅速合并呼吸衰竭12例。撤机好转9例,放弃3例,死亡3例。15例患儿均行喉部CT平扫检查,诊断舌根部囊肿3例,咽旁间隙肿物压迫气管并移位1例。螺旋CT+三维呼吸道重建检查11例,诊断气管狭窄6例,气管分叉处右侧狭窄、肺动脉吊带畸形各2例,可疑气管软化1例。X线胸片示支气管肺炎8例,支气管炎3例,正常4例。11例行超声心动图(UCG)检查显示肺动脉吊带畸形、房间隔缺损各2例,动脉导管未闭1例,正常6例。结论因喉气管病变导致婴幼儿呼吸衰竭并不少见,因其临床表现为非特异性而易致误诊。对撤机困难的有呼吸道阻塞症状的患儿应及时行螺旋CT检查以确诊。
Objective To investigate the clinical characteristics and diagnosis of respiratory failure caused by laryngeal tracheal disease in order to reduce the misdiagnosis cases. Methods The clinical data of 15 children with laryngotracheal tube disease diagnosed as laryngeal airway disease were collected from the ICU hospitalized in our hospital from July 2006 to July 2009. There were 11 males and 4 females, aged 30 days to 22 months. Retrospective analysis of its past medical history, clinical and laryngotracheal spiral CT examination, as well as three-dimensional reconstruction of airway in some children and MRI examination. Results The clinical manifestations were laryngeal wheeze after birth in 7 cases, repeated pulmonary infection in 6 cases, cyanosis after feeding or crying in 5 cases and rapid combination of respiratory failure in 12 cases. Weaning improved in 9 cases, to give up 3 cases, 3 died. Thirteen children underwent CT scan of the larynx to diagnose the tongue root cyst in 3 cases and parapharyngeal space to compress the trachea in 1 case. Spiral CT + reconstruction of three-dimensional airway in 11 cases, diagnosis of tracheal stenosis in 6 cases, tracheal bifurcation in the right side of the stenosis, pulmonary sling deformity in 2 cases, suspected tracheal softening in 1 case. X-ray showed bronchial pneumonia in 8 cases, bronchitis in 3 cases, normal in 4 cases. 11 routine echocardiography (UCG) examination showed pulmonary artery stenosis, atrial septal defect in 2 cases, patent ductus arteriosus in 1 case, normal 6 cases. Conclusion It is not uncommon for respiratory failure caused by laryngotracheal tube disease to be misdiagnosed because of its non-specific clinical manifestations. On the weaning difficulties in children with respiratory obstruction symptoms should be timely spiral CT examination to confirm.