Lin Chen, Chen Chao, Tan Letian, Ni Yihua, Xu Zhengmin
Department of Otorhinolaryngology Head and Neck Surgery，Children's Hospital of Fudan University，Shanghai，201102，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Apr;36(4):264-268. doi: 10.13201/j.issn.2096-7993.2022.04.005.
To disscuss the changes in indications, surgical opportunity and post-operative management of pediatric tracheotomy. Retrospective cohort study of pediatric patients undergoing tracheostomy between January 2016 and December 2020 at Children's Hospital of Fudan University. Ninety-five patients were divided into four groups according to their primary indication. Group A: neuromuscular disease（=36, 37.9%）, Group B: congenital abnormality（=30, 31.6%）, Group C: accidental injury（=15, 15.8%）, Group D: tumor（=14, 14.7%）. By the comparison between four groups, children in group A had higher incidence of Severe pneumonia（47.2%）, higher usage of mechanical ventilation（97.2%）, longer hospitalization days（=84.9 days） and higher rate of Ventilator dependence（66.7%）; children in group B had higher rate of emergency surgery（4.2%）, lower age（median age 2 months） and lower usage of mechanical ventilation（30.0%）; Mortality of the children in group D was the highest（42.9%）. In the recent five years, we saw a increasing tendency in the proportion of group A（28.6%, 35.0%, 38.5%, 44.4%, 43.5%）, and a decreasing tendency of group B（57.1%, 30.0%, 38.5%, 33.3%, 21.7%）. On discharge, 50.5% of children（48 of 95）spontaneously breathe with the tracheos tomy in situ, 29.5% of children（28 of 95）had ventilator-dependence, tracheostomy decannulation was successful in 6.3% of children （6 of 95） and all-cause mortality was 13.7% （13 of 95）. Most paediatric tracheotomies were performed due to chronic underlying diseases. Pediatric tracheostomy should be considered as a long-term intervention in many children. Earlier tracheotomy can shorten the duration of post-tracheotomy mechanical ventilation in several conditions.
探讨小儿气管切开术的适应证、手术时机及术后管理的变化。对2016年1月至2020年12月在复旦大学附属儿科医院接受气管切开术的小儿患者进行回顾性队列研究。95例患者根据其主要适应证分为四组。A组：神经肌肉疾病（=36例，37.9%），B组：先天性异常（=30例，31.6%），C组：意外伤害（=15例，15.8%），D组：肿瘤（=14例，14.7%）。通过四组之间的比较，A组患儿重症肺炎发生率较高（47.2%），机械通气使用率较高（97.2%），住院天数较长（=84.9天），呼吸机依赖率较高（66.7%）；B组患儿急诊手术率较高（4.2%），年龄较小（中位年龄2个月），机械通气使用率较低（30.0%）；D组患儿死亡率最高（42.9%）。近五年，A组比例呈上升趋势（28.6%、35.0%、38.5%、44.4%、43.5%），B组呈下降趋势（57.1%、30.0%、38.5%、33.3%、21.7%）。出院时，50.5%的患儿（95例中的48例）气管切开原位自主呼吸，29.5%的患儿（95例中的28例）有呼吸机依赖，6.3%的患儿（95例中的6例）气管切开拔管成功，全因死亡率为13.7%（95例中的13例）。大多数小儿气管切开术是由于慢性基础疾病而进行的。小儿气管切开术在许多儿童中应被视为一种长期干预措施。在某些情况下，早期气管切开可缩短气管切开术后机械通气的持续时间。
