Hoeve L J, Eskici O, Verwoerd C D
Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus University Rotterdam, The Netherlands.
Int J Pediatr Otorhinolaryngol. 1995 Jan;31(1):7-13. doi: 10.1016/0165-5876(94)01061-2.
The failure to extubate a preterm infant after prolonged intubation is often caused by laryngotracheal injury. This condition is treated by tracheotomy, anterior cricoid split, or often, by reintubation and subsequent extubation attempts in a later stage. To assess the value of reintubation as treatment of post-intubation injury, we retrospectively studied a group of preterm infants from the neonatal intensive care unit in the Sophia Children's Hospital. Three categories of injury were distinguished according to the findings at laryngobronchoscopy: (a) edema or superficial lesions, (b) ulcerations and edema and (c) granulations. Twenty-three infants were therapeutically reintubated after post-intubation injury was diagnosed, for a mean period of 17 days. The therapy was successful in 22 patients, and a failure in one. The follow-up period was a mean 34 months. The result and the duration of the treatment vary with the category of the injury and the condition of the patient. Therapeutic reintubation is compared with alternatives such as anterior cricoid split and tracheotomy. We conclude that reintubation is a valuable therapy that should precede the decision for surgery.
长时间插管后早产儿无法拔管通常是由喉气管损伤引起的。这种情况可通过气管切开术、环状软骨前部劈开术进行治疗，或者通常在后期通过再次插管及随后的拔管尝试来治疗。为了评估再次插管作为插管后损伤治疗方法的价值，我们回顾性研究了一组来自索菲亚儿童医院新生儿重症监护病房的早产儿。根据喉镜检查结果区分出三类损伤：(a) 水肿或浅表病变，(b) 溃疡和水肿，(c) 肉芽组织。23名婴儿在被诊断为插管后损伤后接受了治疗性再次插管，平均持续17天。该治疗在22例患者中成功，1例失败。随访期平均为34个月。治疗结果和持续时间因损伤类别和患者状况而异。将治疗性再次插管与环状软骨前部劈开术和气管切开术等替代方法进行了比较。我们得出结论，再次插管是一种有价值的治疗方法，应在决定手术之前采用。
