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1997 - 2014年先天性气管狭窄患者气管成形术后的临床结果

Clinical outcomes after tracheoplasty in patients with congenital tracheal stenosis in 1997-2014.

作者信息

Yokoi Akiko, Hasegawa Tomomi, Oshima Yoshihiro, Higashide Satoshi, Nakatani Eiji, Kaneda Hideaki, Kawamoto Atsuhiko, Nishijima Eiji

机构信息

Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.

Department of Cardiovascular Surgery, Kobe Children's Hospital, Kobe, Japan.

出版信息

J Pediatr Surg. 2018 Nov;53(11):2140-2144. doi: 10.1016/j.jpedsurg.2017.12.017. Epub 2017 Dec 27.

Abstract

BACKGROUND

Mortality and morbidity of congenital tracheal stenosis (CTS) remain high. The aim of this study was to determine the factors predicting 12-month survival and 2-month successful extubation after tracheoplasty in patients with CTS.

METHODS

Retrospective chart reviews were conducted in patients with CTS undergoing tracheoplasty at a single institution between 1997 and 2014. Patients' characteristics at disease onset and tracheoplasty were summarized. Twelve-month survival rate and 2-month extubation rate without tracheotomy after tracheoplasty were analyzed.

RESULTS

We reviewed 81 patients' records. Multivariate analysis for 12-month survival revealed that older age (>2 months, hazard ratio [HR]: 0.08, 95% confidence interval [CI]: 0.02-0.36) or heavier body weight (>4.4 kg, HR: 0.13, 95% CI: 0.02-0.73) at tracheoplasty was a predictive factor for survival. Body weight at tracheoplasty (>8.2 kg, HR: 3.83, 95% CI: 1.88-7.79), preoperative balloon dilatation (HR: 0.30, 95% CI: 0.12-0.78), and carina involvement (HR: 0.36, 95% CI: 0.19-0.69) were predictive factors for successful extubation.

CONCLUSIONS

Although CTS management is individualized, age or body weight at tracheoplasty needs to be considered and assessed for survival, as well as preoperative balloon dilatation, and carina involvement for successful extubation.

LEVELS OF EVIDENCE

Level III.

摘要

背景

先天性气管狭窄(CTS)的死亡率和发病率仍然很高。本研究的目的是确定预测CTS患者气管成形术后12个月生存率和2个月成功拔管的因素。

方法

对1997年至2014年在单一机构接受气管成形术的CTS患者进行回顾性病历审查。总结了患者发病时和气管成形术时的特征。分析了气管成形术后12个月生存率和2个月无气管切开拔管率。

结果

我们回顾了81例患者的记录。对12个月生存率的多变量分析显示,气管成形术时年龄较大(>2个月,风险比[HR]:0.08,95%置信区间[CI]:0.02-0.36)或体重较重(>4.4 kg,HR:0.13,95%CI:0.02-0.73)是生存的预测因素。气管成形术时的体重(>8.2 kg,HR:3.83,95%CI:1.88-7.79)、术前球囊扩张(HR:0.30,95%CI:0.12-0.78)和隆突受累(HR:0.36,95%CI:0.19-0.69)是成功拔管的预测因素。

结论

尽管CTS的治疗是个体化的,但气管成形术时的年龄或体重对于生存需要加以考虑和评估,术前球囊扩张以及隆突受累情况对于成功拔管也需要考虑和评估。

证据级别

三级。

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