Hatherill M, Reynolds L, Waggie Z, Argent A
Paediatric Intensive Care Unit, Institute of Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, 7700, South Africa.
Arch Dis Child. 2001 Oct;85(4):326-9. doi: 10.1136/adc.85.4.326.
To present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children.
Retrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (PICU) over a five year period.
A total of 148 children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope). Laryngeal ulceration with oedema was documented in 15 of these children (10%), median age 14 months (range 10-36) and median weight 10 kg (range 6-12). Twenty seven of the children who underwent microlaryngoscopy (18%) also had ulcerative gingivostomatitis consistent with herpes simplex virus infection. Ulcerative laryngitis was documented in nine of 27 (33%) children with, and in six of 121 (5%) children without, coexistent ulcerative gingivostomatitis. One of the 15 children did not require airway intervention. Nine children required nasotracheal intubation for a median of 4 days (range 3-11) and median PICU stay of 6 days (range 4-14). Five children required tracheostomy ab initio, with a median PICU stay of 30 days (range 20-36), and duration of tracheostomy in situ for a median of 19 days (range 15-253). All 15 children survived.
Ulcerative laryngitis is more common in our patient population than the few reports suggest. Early diagnostic microlaryngoscopy is recommended in children with severe croup who follow an atypical course.
介绍我们在儿童溃疡性喉炎所致严重上气道梗阻方面的经验。
回顾性病例记录分析，研究对象为5年间入住儿科重症监护病房（PICU）、临床诊断为喉炎且伴有严重上气道梗阻的263例儿童。
共有148例儿童（56%）接受了显微喉镜检查（史托斯3.0硬性望远镜）。其中15例儿童（10%）记录有伴有水肿的喉部溃疡，中位年龄14个月（范围10 - 36个月），中位体重10千克（范围6 - 12千克）。接受显微喉镜检查的儿童中有27例（18%）同时患有与单纯疱疹病毒感染相符的溃疡性龈口炎。在伴有溃疡性龈口炎的27例儿童中有9例（33%）记录有溃疡性喉炎，在无溃疡性龈口炎的121例儿童中有6例（5%）记录有溃疡性喉炎。15例儿童中有1例无需气道干预。9例儿童需要经鼻气管插管，中位插管时间为4天（范围3 - 11天），在PICU的中位住院时间为6天（范围4 - 14天）。5例儿童一开始就需要行气管切开术，在PICU的中位住院时间为30天（范围20 - 36天），气管切开术留置的中位时间为19天（范围15 - 253天）。所有15例儿童均存活。
在我们的患者群体中，溃疡性喉炎比少数报告显示的更为常见。对于病程不典型的重症喉炎儿童，建议早期进行诊断性显微喉镜检查。
