婴儿重症监护室输管的后果:发生率,识别和干预措施
Nicole A Stoler1, Nicole W Segada1, Varsha Varghese1
1Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
概括
新生儿长期输管增加了喉损伤的风险,如下喉狭窄症. 关键的风险因素包括第一次输管时的年龄较大,持续时间较长和更大的内管,需要进一步的干预.
科学领域:
- 新生儿重症监护室新生儿重症监护室
- 儿科耳鼻喉科 儿科耳鼻喉科
- 呼吸系统药物 呼吸系统药物
背景情况:
- 新生儿的长时间输管,特别是那些早产和先天性缺陷的新生儿,是喉损伤的重要危险因素,如下喉狭窄症 (SGS).
- 在新生儿重症监护室 (NICU) 中识别有风险的新生儿对于及时干预和管理至关重要.
研究的目的:
- 为了确定与新生儿喉损伤相关的输管风险因素.
- 为了描述观察到的喉损伤类型.
- 计算这些损伤所需的干预的发生率.
主要方法:
- 从2020年4月到2023年,在四级儿科转诊中心对被直管的新生儿进行了回顾性病例审查.
- 分析电子医疗记录以查看人口统计和输管细节.
- 将患者分为输入管或干预组 (直接喉腔镜和支气管镜[DLB],气管切除术) 的分类.
主要成果:
- 在441名被直管的新生儿中,有94名 (21%) 接受了DLB.
- 干预的风险因素包括更长的妊娠年龄,遗传综合征和先天性心脏病.
- 干预的重要预测因素是第一次输管时的年龄较大,反复发生的输管事件,更长的输管持续时间和更大的内管 (ETT) 直径.
- 下狭窄的发病率为2.95%,其中6.4%需要气球扩张.
- 三分之二的接受DLB的新生儿最终需要进行气管切除术.
结论:
- 第一次输入管时的年龄较大,输入管事件增加,输入管持续时间延长和ETT尺寸较大是喉干预的重要风险因素.
- 出生的体重和输管尝试的数量并不是显著的风险因素.
- 大多数需要DLB的新生儿最终需要进一步的手术,突出了这些输管相关损伤的严重性.
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