目的:确定气管造口术后儿童声门下狭窄(SGS)的发生率,并确定发展的危险因素。
方法:回顾性队列。
方法:纳入2015年至2020年在三级儿童医院接受气管切开术的所有患者(<18岁)。包括直接喉镜(DL)同时进行气管造口术和随后进行DL的患者。医疗记录,包括手术报告,进行了综述,以确定声门下狭窄和相关的危险因素。
结果:共纳入140例患者,气管造口术的平均年龄为2.4岁(标准偏差[SD]:4.3)(中位数:0.5岁,四分位数间距[IQR]:0.3-1.5年)和33.8周(SD:5.9)(中位数:36周,IQR:28-39周)。在初始DL,24%(N=34)患有声门下损伤,26%(N=37)患有SGS。气管造口术后SGS的发生率为每100例患者每年11.5例。在气管造口术中,较低的出生体重(1.8vs.2.3kg,p=0.005),胎龄较短(31.8vs.34.6周,p=0.01),年龄较小(0.8vs.2.9年,p=0.01),较低的重量(5.8与14.7kg,p=0.01),和声门下损伤(44%vs.21%,p=0.01)与SGS的发展有关。多变量逻辑回归分析将出生体重(比值比[OR]:0.49,95%置信区间[CI]:0.31-0.75,p=0.001)和早期声门下损伤(OR:3.22,95%CI:1.31-7.88,p=0.01)与SGS发展相关。
结论:小儿气管切开术后SGS的发生率估计为每年每100例患者11.5例。在这个脆弱的儿童人群中,气管造口术时的低出生体重和声门下损伤与SGS有关。
方法:3喉镜,2024.
OBJECTIVE: To determine the incidence of subglottic stenosis (SGS) in children after tracheostomy and identify risk factors for development.
METHODS: Retrospective cohort.
METHODS: All patients (<18 years) undergoing tracheostomy at a tertiary children\'s hospital between 2015 and 2020 were included. Patients with a direct laryngoscopy (DL) concurrent with tracheostomy and a subsequent DL were included. Medical records, including operative reports, were reviewed to identify subglottic stenosis and associated risk factors.
RESULTS: A total of 140 patients were included with mean age at tracheostomy of 2.4 years (standard deviation [SD]: 4.3) (median: 0.5 years, interquartile range [IQR]: 0.3-1.5 years) and gestational age of 33.8 weeks (SD: 5.9) (median: 36 weeks, IQR: 28-39 weeks). At initial DL, 24% (N = 34) had subglottic injury and 26% (N = 37) developed SGS. The incidence of SGS after tracheostomy was 11.5 cases per 100 patients per year. At tracheostomy, lower birth weight (1.8 vs. 2.3 kg, p = 0.005), shorter gestational age (31.8 vs. 34.6 weeks, p = 0.01), younger age (0.8 vs. 2.9 years, p = 0.01), lower weight (5.8 vs. 14.7 kg, p = 0.01), and subglottic injury (44% vs. 21%, p = 0.01) were associated with the development of SGS. Multivariable logistic regression analysis associated birth weight (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.31-0.75, p = 0.001) and early subglottic injury (OR: 3.22, 95% CI: 1.31-7.88, p = 0.01) with SGS development.
CONCLUSIONS: The incidence of SGS after pediatric tracheostomy is estimated at 11.5 cases per 100 patients per year. Low birth weight and subglottic injury at the time of tracheostomy were associated with SGS in this vulnerable population of children.
METHODS: 3 Laryngoscope, 2024.