Han Kevin D, Seruya Mitchel, Oh Albert K, Zalzal George H, Preciado Diego A
Department of Surgery, Division of Otolaryngology, George Washington School of Medicine Washington, DC, USA.
Ann Otol Rhinol Laryngol. 2012 Jan;121(1):44-50. doi: 10.1177/000348941212100108.
Airway management in infants with Robin sequence (RS) remains controversial, ranging from conservative to operative methods. In some centers, tracheostomy remains the mainstay for those infants with severe respiratory obstruction. The goals of this retrospective case cohort study were to determine the length of time to decannulation without further surgical intervention (ie, "natural" decannulation) in patients with severe RS who underwent tracheostomy and to investigate potential factors associated with successful decannulation.
We reviewed all infants with RS treated at a large tertiary center from 1994 to 2010. Patients who had undergone tracheostomy were identified. Baseline demographics, complications, deaths, and time to "natural" decannulation were recorded. Statistical analysis was performed with univariate analysis and Kaplan-Meier log-rank tests.
Of 61 infants with RS with obstructive events, 25 infants (14 with isolated RS and 11 with syndromic RS) required tracheostomy. At a mean follow-up of 4 years, the rate of tracheostomy-specific complications was 52%; the tracheostomy-specific mortality rate was 12%. Overall, 13 of 25 infants (52%) were "naturally" decannulated, with a median time to decannulation of 97 months. Patients with syndromic RS had a significantly longer median time to decannulation than did those with isolated RS (more than 73 months versus 19 months, respectively; p = 0.019). In addition, patients with long-term tracheostomy dependence had significantly higher maximum carbon dioxide levels before tracheostomy than did patients who were successfully decannulated (82.4 versus 63.2 mEq/L, respectively; p = 0.02).
Tracheostomy in infants with RS is associated with inordinately high rates of mortality, morbidity, and long-term tracheostomy dependence, particularly in patients with syndromic RS and in those with high maximum carbon dioxide levels before tracheostomy.
罗宾序列征（RS）婴儿的气道管理仍存在争议，方法从保守治疗到手术治疗不等。在一些中心，气管造口术仍是那些严重呼吸阻塞婴儿的主要治疗手段。这项回顾性病例队列研究的目的是确定接受气管造口术的重度RS患者在无需进一步手术干预情况下（即“自然”拔管）的拔管时间，并调查与成功拔管相关的潜在因素。
我们回顾了1994年至2010年在一家大型三级中心接受治疗的所有RS婴儿。确定接受过气管造口术的患者。记录基线人口统计学数据、并发症、死亡情况以及“自然”拔管时间。采用单因素分析和Kaplan-Meier对数秩检验进行统计分析。
在61例有阻塞性事件的RS婴儿中，25例婴儿（14例为单纯RS，11例为综合征性RS）需要气管造口术。平均随访4年时，气管造口术特异性并发症发生率为52%；气管造口术特异性死亡率为12%。总体而言，25例婴儿中有13例（52%）“自然”拔管，拔管中位时间为97个月。综合征性RS患者的拔管中位时间显著长于单纯RS患者（分别超过73个月和19个月；p = 0.019）。此外，长期依赖气管造口术的患者气管造口术前的最高二氧化碳水平显著高于成功拔管的患者（分别为82.4和63.2 mEq/L；p = 0.02）。
RS婴儿的气管造口术与极高的死亡率、发病率以及长期气管造口术依赖相关，尤其是综合征性RS患者以及气管造口术前最高二氧化碳水平较高的患者。
