背景:由于常见的呼吸道症状,患有唐氏综合征(DS)的儿童经常接受柔性支气管镜检查(FB)。
目的:为了检查适应症,调查结果,小儿DS患者FB的并发症。
方法:一项2004-2021年在三级中心对DS儿科患者进行的FB进行的回顾性病例对照研究。DS患者根据年龄与对照组(1:3)相匹配,性别,和种族。收集的数据包括人口统计,合并症,适应症,调查结果,和并发症。
结果:50名DS患者(中位年龄1.36岁,56%的男性)和150名对照(平均年龄1.27岁,56%的男性),包括在内。阻塞性睡眠呼吸暂停和氧依赖性的评估是DS中更常见的适应症(38%vs.8%,22%vs.4%,p分别<0.01)。与对照组相比,DS患者的正常支气管镜检查频率较低(8%vs.28%,p=0.01)。DS患者软腭功能不全和气管支气管更常见(12%vs.3.3%,p=0.024,8%与0.7%,分别为p=0.02)。并发症在DS中更常见(22%vs.9%,内部收益率2.36,p=0.028)。在DS中,心脏异常(IRR3.96,p<0.01),肺动脉高压(IRR3.76,p=0.006),术前PICU住院(IRR4.2,p<0.001)与较高的并发症发生率相关。在多元回归模型中,术前心脏病史和PICU住院史,但不是DS,是并发症的独立危险因素,IRR分别为4和3.1(p=0.006,p=0.05)。
结论:接受FB的DS儿科患者是具有特定适应症和发现的独特人群。患有心脏异常和肺动脉高压的DS儿科患者发生并发症的风险最高。本文受版权保护。保留所有权利。
Children with Down syndrome (DS) often undergo flexible bronchoscopies (FB) due to common respiratory symptoms.
To examine the indications, findings, and complications of FB in pediatric DS patients.
A retrospective case-control
study on FB performed in DS pediatric patients between 2004 and 2021 in a tertiary center. DS patients were matched to controls (1:3) based on age, gender, and ethnicity. Data collected included demographics, comorbidities, indications, findings, and complications.
Fifty DS patients (median age 1.36 years, 56% males) and 150 controls (median age 1.27 years, 56% males), were included. Evaluation for obstructive sleep apnea and oxygen dependence were more common indications among DS (38% vs. 8%, 22% vs. 4%, p < 0.01, respectively). Normal bronchoscopy was less frequent in DS compared with controls (8% vs. 28%, p = 0.01). Soft palate incompetence and tracheal bronchus were more frequent in DS (12% vs. 3.3%, p = 0.024, 8% vs. 0.7%, p = 0.02, respectively). Complications were more frequent in DS (22% vs. 9.3%, incidence rate ratio [IRR] 2.36, p = 0.028). In DS, cardiac anomalies (IRR 3.96, p < 0.01), pulmonary hypertension (IRR 3.76, p = 0.006), and pediatric intensive care unit (PICU) hospitalization before the procedure (IRR 4.2, p < 0.001) were associated with higher complication rates. In a multivariate regression model, history of cardiac disease and PICU hospitalization before the procedure, but not DS, were independent risk factors for complications with an IRR of 4 and 3.1, respectively (p = 0.006, p = 0.05).
DS pediatric patients undergoing FB are a unique population with specific indications and findings. DS pediatric patients with cardiac anomalies and pulmonary hypertension are at the highest risk for complications.