Ting Jose, Roy Soham, Navuluri Sriram, Hanfland Robert, Mulcahy Lauren, Yuksel Sancak, Huang Zhen, Jiang Zi Yang
University of Texas McGovern Medical School Department of Otorhinolaryngology - Head and Neck Surgery, United States.
University of Texas McGovern Medical School Department of Pediatric Surgery, United States.
Int J Pediatr Otorhinolaryngol. 2018 Aug;111:115-118. doi: 10.1016/j.ijporl.2018.06.004. Epub 2018 Jun 5.
Children with single ventricle cardiac physiology (SVC) often require airway procedures as an adjunct to their care. Descriptive analysis with a focus on outcomes of airway procedures in SVC patients have not been fully described in the literature.
Retrospective, single-center cohort review of 270 patients born between Aug-2007 and Jan-2017. Patients were identified by cardiac database for single ventricle pathophysiology. A subset of these patients were identified to have been evaluated by otolaryngology with airway evaluations and/or interventions.
88/270 patients (32.6%) required investigation or intervention for airway pathology. The most frequent procedure was flexible fiberoptic laryngoscopy (58/88 patients); it was the only procedure performed in 40 patients. Seventeen patients required tracheostomies with an associated increased length of stay (p < 0.001). Patients with cardiac procedures involving dissection around the aortic arch were considered higher airway risk due to the threat of recurrent laryngeal nerve injury, and were more likely to have vocal cord paralysis (58%) compared to patients with lower risk procedures (21%; p < 0.001). However, on multivariate logistic regression, vocal cord paralysis did not statistically impact the odds for tracheostomy placement, although the presence of subglottic stenosis increased the odds ratio of tracheostomy by 14.7 (p = 0.02).
Children with SVC often require airway evaluation and intervention. Patients with high risk cardiac procedures had a higher risk of recurrent laryngeal nerve injury but the presence of subglottic stenosis was the best predictor for a tracheostomy. This study represents one of the largest series of SVC children evaluated for airway pathology.
单心室心脏生理（SVC）患儿在治疗过程中常需进行气道手术作为辅助治疗。目前关于SVC患者气道手术结局的描述性分析在文献中尚未得到充分阐述。
对2007年8月至2017年1月期间出生的270例患者进行回顾性单中心队列研究。通过心脏数据库识别患有单心室病理生理的患者。其中一部分患者经耳鼻喉科进行了气道评估和/或干预。
88/270例患者（32.6%）因气道病变需要进行检查或干预。最常见的手术是可弯曲纤维喉镜检查（58/88例患者）；40例患者仅接受了该手术。17例患者需要进行气管切开术，且住院时间相应延长（p<0.001）。由于存在喉返神经损伤的风险，涉及主动脉弓周围解剖的心脏手术患者被认为气道风险较高，与低风险手术患者相比，其声带麻痹的发生率更高（58%对21%；p<0.001）。然而，在多因素逻辑回归分析中，声带麻痹在统计学上对气管切开术的发生几率没有影响，尽管声门下狭窄的存在使气管切开术的比值比增加了14.7（p=0.02）。
SVC患儿常需进行气道评估和干预。高风险心脏手术患者喉返神经损伤的风险较高，但声门下狭窄是气管切开术的最佳预测因素。本研究是评估气道病变的最大系列SVC患儿研究之一。
