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先天性鼻后孔闭锁!21天新生儿有鼻子却不能呼吸

2017-10-11 13:41:53   

央广网武汉10月11日消息(记者凌姝 通讯员薛源)新生小宝宝出现不明原因的呼吸困难、嘴唇青紫。妈妈肖女士说,“宝宝鼻子里好像被什么东西塞住了似的,在喂奶的时候就更加明显了,吮吸起来很是吃力”。经武汉儿童医院确诊为先天性鼻后孔骨性闭锁,而且是双侧。手术后,小宝宝终于呼吸顺畅了。

怀胎十月,随着一声清脆的啼哭,小航航(化名)出生了,是个看起来发育健全的男婴,妈妈肖女士及家人都沉浸在喜悦中。

可就在航航出生没一会,给孩子喂奶时,妈妈肖女士发现,孩子呼吸得很急促,鼻子里好像有什么东西塞住了似的,不一会,小航航的嘴唇便青紫起来。

小航航立即被转往当地妇幼保健院新生儿科治疗,经过医生的抢救治疗,好几天过去了,虽然呼吸困难有所好转,但完全不能停氧,当地医院没有找到呼吸困难的根本原因,建议家长把小航航转往武汉儿童医院治疗。

武汉儿童医院新生儿内科主任医师刘汉楚及其科室医护人员对小航航进行了积极全面的诊治。虽然新生儿发生呼吸困难的原因很多也很复杂,但还是很快找到了突破口。经鼻咽部的CT检查提示,小航航的双侧鼻后孔呈完全封闭状态,是先天性的鼻后孔骨性闭锁。电子纤维镜检查结果也支持这一诊断。

耳鼻喉科主任医师夏忠芳在查看刚出生21天的小航航后,建议立即手术。在新生儿科医生的充分准备、麻醉科医生的积极配合下,对小航航进行了“鼻后孔形成术”,手术很成功,小航航骨性闭锁的鼻后孔终于被打通了,为了避免术后再次闭锁和狭窄,在打开的鼻后孔中还植入了导管支撑。

手术后第二天,新生儿科的医生逐步调低了呼吸机参数,小航航的各项监护指标也正常,医生拔出气管插管,撤离呼吸机,改鼻导管吸氧。

鼻子打通了,小航航恢复了自主呼吸,血氧饱和度也维持在正常水平。经过新生儿科的精心护理,几天后,小航航顺利出院了。抱着呼吸平稳的孩子,肖女士及家人的脸上露出了久违的笑容。

夏忠芳主任医师介绍,像航航这种双侧鼻后孔骨性闭锁的患儿,如果不能及时实施手术,会出现呼吸困难、不会吸吮,严重的最终可导致窒息死亡或饥饿致死。

离手术已过了1个月,目前小航航的鼻后孔中的导管已经拔出,伤口恢复的很好,与正常小孩无异。

专家提醒,当发现刚出生的小婴儿出现呼吸困难、紫绀及窒息,心肺查体无异常时,则应高度警惕是先天性鼻后孔闭锁的可能,应带孩子及时到医院就诊。

值得注意的是,对于单侧鼻后孔闭锁的患儿,由于呼吸困难症状并不明显,较难被发现,如遇到孩子常常固定一侧鼻孔不通、常流鼻涕,家长应多多留意。对于先天性鼻后孔闭锁的孩子来说,专家建议,及早发现并尽早帮他们建立呼吸通路是非常重要的。

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