| 摘要: |
| ［摘要］ 目的 分析176例中心气道狭窄患儿的临床资料，总结儿童中心气道狭窄的病因分布和临床特征，为诊治儿童中心气道狭窄提供参考。方法 回顾性分析2018年1月至2023年12月广州医科大学附属第一医院收治的176例中心气道狭窄患儿的临床资料，包括一般资料，中心气道狭窄病因和部位，住院期间首次肺功能检查结果、CT和支气管镜检查结果，入院时血气分析结果、临床表现。结果 176例中心气道狭窄患儿中，男120例（68.18%），女56例（31.82%），中位月龄17个月。先天性中心气道狭窄（25.00%，44/176）的主要病因是先天性气道发育畸形（18.18%，32/176），其中以12～35月龄患儿占比最高（37.50%，12/32）。后天获得性中心气道狭窄（75.00%，132/176）的主要病因依次为气管插管或者气管切开（35.23%，62/176）、气道异物（17.05%，30/176）和气道感染（15.91%，28/176），其中气管插管或者气管切开患儿以≥36月龄占比最高（43.55%，27/62）。声门下狭窄（39.20%，69/176）及单右主支气管或右中间段支气管、左主支气管狭窄（37.50%，66/176）占比较高，其中声门下狭窄的病因主要为气管插管或者气管切开（78.26%，54/69）。7例患儿行肺通气功能检查，结果均提示不同程度的阻塞性通气功能障碍。109例患儿接受血气分析，结果显示氧分压（PaO2）下降44例（40.37%），二氧化碳分压（PaCO2）上升35例（32.11%），pH下降29例（26.61%），实际碳酸氢根离子浓度上升38例（34.86%），碱剩余上升22例（20.18%）。临床表现主要为咳嗽、喘息、气促和三凹征。CT、支气管镜检查中心气道狭窄的检出率分别为80.46%、100.00%。结论 各病因患儿中不同月龄段占比、中心气道各狭窄部位的主要病因存在差异。后天获得性中心气道狭窄的主要病因依次为气管插管或者气管切开、气道异物和气道感染。 |
| 关键词: 中心气道狭窄 先天性气道发育畸形 气道异物 儿童 |
| DOI：10.3969/j.issn.1674-3806.2025.07.12 |
| 分类号: |
| 基金项目:广州市科技计划项目（编号：2023A03J0331，2023A03J0332）；广州市卫生健康科技项目（编号：20242A011020） |
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| Analysis on clinical data of 176 pediatric patients with central airway stenosis |
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TANG Sixiang, WU Shangzhi, LI Hongwei, LIN Junxing, XU Qingyun, LIN Yuneng, XU Jiaxing, LONG Jitong, HUANG Zhanhang, CHEN Dehui
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Department of Pediatrics, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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| Abstract: |
| ［Abstract］ Objective To analyze the clinical data of 176 pediatric patients with central airway stenosis and to summarize the etiological distribution and clinical features of central airway stenosis in the pediatric patients, providing reference for the diagnosis and treatment of central airway stenosis in pediatric patients. Methods The clinical data of 176 pediatric patients with central airway stenosis who were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2018 to December 2023 were retrospectively analyzed. The clinical data included the pediatric patients′ general data, causes and locations of central airway stenosis, results of the first pulmonary function test, and results of computed tomography(CT) and bronchoscopy during their hospitalization, and results of blood gas analysis and clinical manifestation at admission. Results Among the 176 pediatric patients with central airway stenosis, 120 pediatric patients were male(68.18%) and 56 pediatric patients were female(31.82%). The median age was 17 months. The main causes of congenital central airway stenosis(25.00%, 44/176) were congenital pulmonary airway malformation(18.18%, 32/176), among them, the pediatric patients aged 12-35 months accounted for the highest proportion(37.50%, 12/32). The main causes of acquired central airway stenosis(75.00%, 132/176) were tracheal intubation or tracheotomy(35.23%, 62/176), airway foreign body(17.05%, 30/176) and airway infection(15.91%, 28/176) in sequence, among them, the proportion of the pediatric patients aged ≥36 months who underwent tracheal intubation or tracheotomy was the highest(43.55%, 27/62). The subglottic stenosis(39.20%, 69/176) and the stenosis in the right main bronchus or the right middle bronchus, and the left main bronchus(37.50%, 66/176) accounted for a relatively high proportion. The main cause of subglottic stenosis was tracheal intubation or tracheotomy(78.26%, 54/69). Pulmonary ventilation function test was performed on 7 pediatric patients, and the results indicated obstructive ventilation dysfunction in varying degrees. Blood gas analysis was performed on 109 pediatric patients, and the results showed that partial pressure of oxygen(PaO2) decreased in 44 cases(40.37%), partial pressure of carbon dioxide(PaCO2) increased in 35 cases(32.11%), pH decreased in 29 cases(26.61%), actual bicarbonate ion concentration increased in 38 cases(34.86%), and base excess increased in 22 cases(20.18%). The main clinical manifestations of the pediatric patients were cough, wheezing, shortness of breath and three-concave sign. The detection rates of central airway stenosis by using CT and using bronchoscopy were 80.46% and 100.00%, respectively. Conclusion The proportions of the pediatric patients with different etiologies in different age groups and the main causes of each stenosis location in the central airway are different. The main causes of acquired central airway stenosis are tracheal intubation or tracheotomy, airway foreign body and airway infection in sequence. |
| Key words: Central airway stenosis Congenital pulmonary airway malformation Airway foreign body Children |
