先天性上气道疾病相关性吸入性肺炎72例病例系列报告

目的 探讨先天性上气道疾病相关性吸入性肺炎的临床特点。方法 选择2014年12月1日至2018年6月30日在复旦大学附属儿科医院住院明确有上气道疾病的吸入性肺炎患儿,回顾性收集临床资料进行分析,并按是否合并神经系统疾病分组。结果 72例进入本文分析,男47例,中位年龄4个月。上气道疾病种类中,单纯喉软化最常见(59.7%),可合并下气道及其他系统异常。主要临床症状以咳嗽、呛奶、喘息最常见。80.6%患儿起病年龄＜3个月。69例患儿行核素唾液显像检查,肺吸入54例(78.3%);35例行上消化道造影检查,肺吸入20例(57.1%);64例行电子纤维喉镜检查,上气道异常61例(95.3%);27例行软式支气管镜检查,上气道异常13例(48.1%),下气道异常7例(25.9%)。病原学阳性50例(69.4%)。54例接受鼻饲喂养。15例需要ICU治疗。3例死亡。合并神经系统疾病患儿更易反复肺炎,住院费用更高。结论 先天性上气道疾病相关性吸入性肺炎多在生后3个月内起病,容易出现气道复合病变以及呼吸系统外合并症,伴有神经系统异常患儿更易反复肺炎,疾病负担更重。内窥镜、核素唾液显像等检查有助于疾病诊断。

Report of 72 cases of congenital upper airway disease-associated aspiration pneumonia

Objective To explore the characteristics of aspiration pneumonia in children with congenital upper airway dis-eases.Methods A retrospective review was performed on hospitalized children with a documented diagnosis of congenital upper airway disease and aspiration pneumonia at a tertiary children's hospital from December 2014 to June 2018. Differences were evaluated between cases with and without neurologic impairment.Results A total of 72 cases were reviewed, including 47 males and 25 females, with median age of 4 months. Laryngomalacia was the most common upper airway lesion with a high rate of compound lower airway lesions and other comorbidities. Main clinical manifestations were coughing, choking and wheezing. The vast majority (80.6%) of children had onset of symptoms before 3 months of age. Fifty-four out of 69 cases showed positive aspiration findings in radionuclide salivagram. Twenty out of 35 cases showed positive aspiration findings in upper gastrointestinal series. Flexible laryngoscopy identified 61 cases with upper airway lesion among 64 children. Flexible bronchoscopy identified 13 cases with upper airway lesion and 7 cases with lower airway lesion among 27 children. Fifty cases showed positive pathogen findings. Fifty-four cases received nasogastric tube feeding. Fifteen received ICU treatment and 3 cases died finally. Those with neurologic impairment were more likely to have recurrent pneumonia and had higher cost for hospitalization.Conclusion Children with aspiration pneumonia and congenital upper airway diseases usually present with symptoms before 3 months of age. They have a high prevalence of synchronous airway lesions and other comorbidities. Patients with neurologic impairment combined are more likely to have recurrent pneumonia and higher financial burden. Endoscopy and radionuclide salivagram are useful tools for diagnosis.