12例小儿急性上呼吸道梗阻的病因

Etiology of acute upper respiratory tract obstruction in infants: analysis of 12 cases

摘要:

目的：总结小儿急性上呼吸道梗阻的发生原因,以减少误诊率和病死率。方法：分析2007年3~12月该院儿科PICU住院的全部急性上呼吸道梗阻患儿(12例)的临床资料。全部病例均完成了胸部X线片、喉镜检查、喉部及肺部CT扫描及三维重建检查。结果：12例患儿院外诊断为先天性单纯性喉喘鸣（8例，67%）、急性喉炎等。入院后12例中4例(33%)经喉部CT扫描诊断为先天性甲状舌管囊肿, 1例(8%)为咽后壁脓气肿，1例(8%)为左颈部淋巴管瘤，2例(16%)为声门下狭窄，4例(33%)为急性喉炎。院外诊断与入院后诊断相比误诊率为67%。结论：小儿急性上呼吸道梗阻喉喘鸣非常容易误诊,尤其是婴幼儿，必须排除引起喉喘鸣的其他病理因素(如占位病变,先天性因素等)方可拟诊先天性单纯性喉喘鸣。甲状舌管囊肿是新生儿及婴幼儿喉喘鸣的常见原因之一，临床误诊率较高。因此，建议将喉镜检查作为新生儿及婴幼儿喉喘鸣的常规筛选手段,有条件者可进行喉部、肺CT扫描及三维重建检查。［中国当代儿科杂志，2009，11（2）：116-119］

Abstract:

OBJECTIVE: To study the etiology of acute upper respiratory tract obstruction in infants. METHODS: The medical data of 12 infants with acute upper respiratory tract obstruction were retrospectively reviewed. The patients received the examinations of laryngoscopy and CT scans for larynx and lungs. RESULTS: All of the 12 infants presented with laryngeal stridor. Eight infants (67%) were diagnosed as congenital simple laryngeal stridor before admission. Based on the clinical features, laboratory examinations, imaging examinations and laryngoscopy, 4 (33%) were definitely diagnosed with thyroglossal ductal cyst, 1(8%) with abscess-emphysema in the posterior wall of pharynx, 1(8%) with cervicallymphangioma, 2 (16%) with subglottic stenosis, and 4 (33%) with acute laryngitis. CONCLUSIONS: Acute upper respiratory tract obstruction is easily misdiagnosed in infants. Thyroglossal duct cyst is a common cause of upper respiratory tract obstruction/laryngeal stridor. It is recommend that laryngoscopy and CT scans for larynx should be performed in infants with laryngeal stridor.［Chin J Contemp Pediatr, 2009, 11 (2):116-119］