背景:这项研究的目的是在诊断时检查呼吸系统并发症的危险因素,并建立儿童和青少年纵隔肿瘤的临床管理算法。
方法:我们回顾性收集了1999年至2019年在Sa玉儿童医疗中心出现纵隔肿瘤的所有儿童和青少年的临床资料,包括年龄,性别,病理诊断,八种主要临床症状(咳嗽,呼吸困难,缺氧,端坐呼吸,胸痛,喘息,上腔静脉综合征,和喘鸣),胸部计算机断层扫描(CT)发现(肿瘤位置,纵隔质量比,胸腔积液,心包积液,和压缩气管和支气管),诊断程序和麻醉的类型,呼吸系统并发症(严重缺氧,通风困难,呼吸衰竭,和心肺骤停),和临床结果。随后,我们结合临床和放射学检查结果,计算了预测呼吸系统并发症的风险评分.
结果:在57例患者中,7(12%)产生呼吸道并发症。咳嗽,呼吸困难,缺氧,和端坐呼吸在有并发症的患者中明显更常见(分别为p=0.02,p=0.02,p<0.01,p=0.03)。在有并发症的患者中,胸部CT中气管横截面积(%TCA)的百分比减小和隆突受压也明显更常见(分别为p<0.01和<0.01)。我们结合咳嗽计算呼吸道并发症的风险评分,喘息,stridor,端坐呼吸,呼吸困难,缺氧,%TCA<0.5,并压缩隆突。风险评分≥7对并发症的预测准确性较高(敏感性:100%,特异性:97.7%,正似然比:43.0)。
结论:将临床症状与放射学结果相结合的风险评分是纵隔肿瘤患儿呼吸系统并发症的一个有希望的预测工具。
The aim of this study was to examine risk factors of respiratory complications at the diagnosis and establish an algorithm of clinical management in children and adolescents with mediastinal tumors.
We retrospectively collected clinical information of all children and adolescents who presented with mediastinal tumors at Saitama Children\'s Medical Center from 1999 to 2019, including age, sex, pathological diagnosis, eight major clinical symptoms (cough, dyspnea, hypoxia, orthopnea, chest pain, wheeze, superior vena cava syndrome, and stridor), chest computed tomography (CT) findings (tumor location, mediastinal mass ratio, pleural fluid, pericardial effusion, and compression of trachea and bronchi), types of diagnostic procedure and anesthesia, respiratory complications (severe hypoxia, difficult ventilation, respiratory failure, and cardiopulmonary arrest), and clinical outcome. Subsequently, we calculated the risk score for predicting respiratory complications by combining clinical and radiological findings.
Of the 57 patients, 7 (12%) developed respiratory complications. Cough, dyspnea, hypoxia, and orthopnea were significantly more common in patients with complications (p = 0.02, p = 0.02, p < 0.01, p = 0.03, respectively). The reduction of percentage of tracheal cross-sectional area (%TCA) and compression of the carina in chest CT were also significantly more common in patients with complications (p < 0.01 and <0.01, respectively). We calculated the risk score of respiratory complications by combining cough, wheeze, stridor, orthopnea, dyspnea, hypoxia, %TCA < 0.5, and compression of the carina. A risk score ≥ 7 showed high predictive accuracy for complications (sensitivity: 100%, specificity: 97.7%, positive likelihood ratio: 43.0).
The risk score combining clinical symptoms with radiological findings is a promising predictive tool for respiratory complications in children with mediastinal tumors.