预测罗宾序列婴儿保守气道管理失败:EARN因素
Jennifer L McGrath1, Esperanza Mantilla-Rivas1, Marudeen Aivaz1
1From the Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA.
概括
一些多睡眠学发现预测了罗宾序列 (RS) 的婴儿在保守的呼吸道管理下不会得到改善的情况. 这些因素可以帮助识别需要早些时候进行严重上呼吸道阻塞 (UAO) 手术的婴儿.
科学领域:
- 儿科耳鼻喉科 儿科耳鼻喉科
- 睡眠医学 睡眠医学
- 新生儿科学 新生儿科学
背景情况:
- 罗宾序列 (RS) 在婴儿呼吸道管理中提出了重大挑战.
- 保守的气道措施通常是最初的方法,但成功率各不相同.
- 如果不能谨慎管理,可能会导致长时间的上呼吸道阻塞 (UAO) 和潜在的并发症.
研究的目的:
- 为了比较单独保守管理RS的婴儿与需要手术干预的婴儿.
- 确定RS中保守的气道管理失败的预测因素.
- 潜在地加速严重UAO的婴儿的最终治疗.
主要方法:
- 一个前性收集的122名RS婴儿数据库的回顾性审查.
- 在成功的保守管理 (第一组) 和手术干预 (第二组) 组之间,人口,营养,呼吸和多睡眠学数据的比较.
- 接收机操作特征 (ROC) 曲线分析,以确定保守管理失败的预测变量.
主要成果:
- 几个变量在各组之间存在显著差异.
- 特定的多睡眠学发现,称为"EARN"因素,对失败的保守管理有很高的预测能力:
- 潮尾CO2 (最大) > 49mmHg,呼吸暂停-呼吸暂停指数 (AHI) > 16.9事件/小时,REM期间阻塞性呼吸暂停-呼吸暂停指数 (OAHI) > 25.9事件/小时,非REM期间的OAHI > 23.6事件/小时.
结论:
- 在RS的婴儿中,与严重的UAO相关的特定多睡眠因子 (EARN) 已被确定.
- 这些因素表明,仅仅通过保守的呼吸道管理,预后不佳.
- 使用这些预测因素的早期识别可能会促进及时的外科干预,减少与长期UAO相关的风险.
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