新生儿重度上呼吸道梗阻的病因分析

目的了解新生儿重度上呼吸道梗阻的原因。方法回顾性分析47例发生重度吸气性呼吸困难的新生儿的临床表现、直接喉镜、CT、上消化道造影等检查结果及治疗经过。结果47例中先天性疾病占87．2％（41／47）：先天性喉喘鸣15例，占31．9％，其中6例伴有胃食管反流；上呼吸道先天性囊肿14例（舌根囊肿10例，会厌囊肿3例，喉囊肿1例），占29．8％，其中有13例曾被误诊为先天性喉喘鸣；先天性总气管狭窄3例；先天性喉蹼2例；声带麻痹2例；皮耶-罗宾综合征3例；猫叫综合征2例。急性膜性喉气管支气管炎6例。47例中3例放弃治疗，44例经吸氧、药物治疗后呼吸困难缓解，其中曾行气管插管、吸痰37例次，行直接喉镜、支撑喉镜手术19例次。结论新生儿重度上呼吸道梗阻病因以先天性疾病为主，对这类患儿应及时进行相关检查，尽早明确病因，迅速解除梗阻，以降低新生儿死亡率和预防不良后遗症的发生。

Etiologic analysis of severe neonatal upper respiratory tract obstruction

OBJECTIVE: To investigate the causes of severe upper respiratory tract obstruction in neonates. METHODS: Forty seven cases with severe dyspnea history were reviewed and retrospective analysis performed. Clinical manifestation, direct laryngoscope, CT, X-ray barium meal examination results and the treatment process were recorded. RESULTS: Among 47 neonates, 41 cases were congenital diseases, accounting for 87.2% (41/47). In 41 cases, 15 cases were congenital laryngeal stridor, accounting for 31.9%, involving 6 cases accompanied by the gastroesophageal reflux. Fourteen cases were congenital upper respiratory tract cyst (10 cases of lingual root cyst, 3 cases of epiglottis cyst, 1 case of laryngeal cyst), accounting for 29.8%, in which 13 cases were misdiagnosis as congenital laryngeal stridor. Others were 6 cases of acute membrane laryngotracheo branchitis, 3 cases of congenital main respiratory tract stenosis, 2 cases of congenital laryngeal webs, 2 cases of vocal cord paralysis, 3 cases of Pierre Robin syndrome, 2 cases of Cri-du-chat syndrome. Except for 3 in 47 cases whose parents refused treatment, dyspnea in other 44 cases were relieved with inhaling oxygen and drug treatment, 37 case received tracheal intubation and sputum suction, 19 cases received direct larrygoscope or self-retaining larrygoscope operation. CONCLUSIONS: Congenital disease is the main cause of severe upper respiratory tract obstruction. For the neonates suffering from severe upper respiratory obstruction, finding out the cause and prompt treatment are essential for prognosis and reducing mortality.