新生儿双侧声带麻痹临床特点及预后分析

目的 探讨新生儿双侧声带麻痹的病因、临床特点、治疗及预后转归。 方法 对新生儿中心在2016年1月至2020年12月期间收治的双侧声带麻痹患儿进行回顾性分析,记录患儿的基本资料、病因、治疗情况及预后情况,并对患儿进行门诊及电话随访。 结果 共纳入28例患儿,男18例,女10例,年龄1~24 d,中位年龄3.5 d。92.9%(26/28)的患儿为足月儿,53.6%(15/28)的患儿为剖宫产。患儿首发症状主要为吸气性喉鸣及呼吸困难,占比高达78.6%(22/28),其次为呛奶及呕吐,占比为14.3%(4/28)。先天性双侧声带麻痹23例(82.1%,23/28),其中合并中枢神经系统病变7例(23.8%),先天性心脏病6例(21.4%),喉气管疾病6例(21.4%),胃食管反流疾病2例(7.1%);后天获得性声带麻痹5例(17.9%,5/28),获得性因素中多发于食管、气管疾病术后(80%,4/5)。全部患儿中8例(28.6%)行气管切开。所有患儿随访时间1个月~4年,死亡4例。气管切开患儿8例中,1例12个月时顺利拔管,1例堵管中,余5例目前随访16~47个月声带仍无恢复。观察等待20例患儿中,11例(64.7%)在后期随访的1~38个月内痊愈,声带活动恢复,6例(35.3%)在后期随访的5~17个月内声带活动改善,活动后喉鸣。 结论 新生儿双侧声带麻痹病因以先天性多见,共患病因素多,临床多表现为喉鸣及呼吸困难,部分有吞咽困难。气管切开术在新生儿双侧声带麻痹中并不是普遍必要的,多数先天性双侧声带麻痹患儿可自行恢复,预后较好,不要过早行外科手术干预。

Clinical characteristics and outcomes of neonates with bilateral vocal cord paralysis

Objective The objective of this study is to investigate the etiology, clinical characteristics, treatment, and outcomes of bilateral vocal cord paralysis(BVCP)in neonates. Methods We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP by endoscopy at the Department of Neonatal Center between January 2016 and December 2020. We collected the information, etiology, treatment, and outcomes of the children. Follow-up sessions were conducted in the clinic or by telephone, and relevant information were recorded. Results This study included a total of 28 patients consisting of 18 males and 10 females. Their ages ranged from one to 24 days, with a median age of 3.5 days. The main findings can be summarized into three points. First, 92.9% of the neonates were full-term and 53.6% were born by caesarean delivery. The most common clinical symptoms were inspiratory stridor and dyspnea, present in 78.6% of patients. This was followed by aspiration and vomiting, which were present in 14.3% of patients. Second, the etiology was congenital in 82.1% and acquired in 17.9% of the infants. In the congenital BVCP cases, there were seven cases of congenital central nervous system diseases, six(21.4%)of congenital heart diseases, six(21.4%)of laryngotracheal diseases, and two(7.1%)of gastroesophageal reflux diseases. Most of the acquired factors were secondary to postoperative esophageal and tracheal diseases(75%). Third, among all the patients, eight(28.6%)underwent tracheotomy. Of the eight cases, one died, one(14.3%)was successfully extubated at the age of 12 months, one had the trachea blocked, and the remaining five cases have not recovered even after conducting follow-up sessions for 16-47 months. Among the remaining 20 patients waiting for observation, three cases died. Of the remaining 17 cases, 11(64.7%)cases recovered within 1-38 months of late follow-up, and six cases(35.3%)had improved vocal cord activity within 5-17 months of late follow-up. All in all, the follow-up time ranged from one month to four years, and four patients died. Conclusion BVCP in neonates is most commonly congenital in nature and has many comorbidity factors. Most of the clinical manifestations we observed were stridor, dyspnea, and occasionally, dysphagia. Tracheotomy is generally not necessary in treating neonatal BVCP. Most children with BVCP can recover by themselves and have good prognoses, so surgical intervention should not be done too early.