儿童纵隔肿瘤呼吸并发症的预测风险评分：病例对照研究。

Predictive risk score of respiratory complications in children with mediastinal tumors: A case-control study.

机构信息

Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.

Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.

出版信息

Cancer Med. 2023 Jan;12(2):1167-1176. doi: 10.1002/cam4.4972. Epub 2022 Jun 23.

DOI:10.1002/cam4.4972

PMID:35748036

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9883441/

Abstract

BACKGROUND

The aim of this study was to examine risk factors of respiratory complications at the diagnosis and establish an algorithm of clinical management in children and adolescents with mediastinal tumors.

METHODS

We retrospectively collected clinical information of all children and adolescents who presented with mediastinal tumors at Saitama Children's Medical Center from 1999 to 2019, including age, sex, pathological diagnosis, eight major clinical symptoms (cough, dyspnea, hypoxia, orthopnea, chest pain, wheeze, superior vena cava syndrome, and stridor), chest computed tomography (CT) findings (tumor location, mediastinal mass ratio, pleural fluid, pericardial effusion, and compression of trachea and bronchi), types of diagnostic procedure and anesthesia, respiratory complications (severe hypoxia, difficult ventilation, respiratory failure, and cardiopulmonary arrest), and clinical outcome. Subsequently, we calculated the risk score for predicting respiratory complications by combining clinical and radiological findings.

RESULTS

Of the 57 patients, 7 (12%) developed respiratory complications. Cough, dyspnea, hypoxia, and orthopnea were significantly more common in patients with complications (p = 0.02, p = 0.02, p < 0.01, p = 0.03, respectively). The reduction of percentage of tracheal cross-sectional area (%TCA) and compression of the carina in chest CT were also significantly more common in patients with complications (p < 0.01 and <0.01, respectively). We calculated the risk score of respiratory complications by combining cough, wheeze, stridor, orthopnea, dyspnea, hypoxia, %TCA < 0.5, and compression of the carina. A risk score ≥ 7 showed high predictive accuracy for complications (sensitivity: 100%, specificity: 97.7%, positive likelihood ratio: 43.0).

CONCLUSION

The risk score combining clinical symptoms with radiological findings is a promising predictive tool for respiratory complications in children with mediastinal tumors.

摘要

背景

本研究旨在探讨纵隔肿瘤患儿诊断时发生呼吸系统并发症的危险因素，并建立一种临床管理算法。

方法

我们回顾性收集了 1999 年至 2019 年在埼玉儿童医疗中心就诊的所有纵隔肿瘤患儿的临床信息，包括年龄、性别、病理诊断、八大主要临床症状（咳嗽、呼吸困难、缺氧、端坐呼吸、胸痛、喘息、上腔静脉综合征和喘鸣）、胸部计算机断层扫描（CT）表现（肿瘤位置、纵隔肿块比、胸腔积液、心包积液和气管及支气管受压）、诊断程序和麻醉类型、呼吸系统并发症（严重缺氧、通气困难、呼吸衰竭和心肺骤停）以及临床转归。随后，我们结合临床和影像学表现计算出预测呼吸系统并发症的风险评分。

结果

在 57 例患者中，有 7 例（12%）发生了呼吸系统并发症。有并发症的患者咳嗽、呼吸困难、缺氧和端坐呼吸更为常见（p=0.02、p=0.02、p<0.01、p=0.03）。胸部 CT 显示气管横截面积百分比（%TCA）降低和隆突受压也更为常见（p<0.01 和 p<0.01）。我们通过结合咳嗽、喘息、喘鸣、端坐呼吸、呼吸困难、缺氧、%TCA<0.5 和隆突受压计算出呼吸系统并发症的风险评分。风险评分≥7 对并发症具有较高的预测准确性（敏感性：100%，特异性：97.7%，阳性似然比：43.0）。