Bentsianov B L, Parhiscar A, Azer M, Har-El G
Department of Otolaryngology, Long Island College Hospital, Brooklyn, New York, USA.
Laryngoscope. 2000 Dec;110(12):2016-9. doi: 10.1097/00005537-200012000-00007.
Angioneurotic edema of the upper aerodigestive tract (AEUAT) often challenges the otolaryngologist with the decision of surgical intervention versus observation.
To develop a logical approach to the evaluation and management of the airway in patients with AEUAT, emphasizing fiberoptic examination (FOE) findings.
A computer-based retrospective review of all patients diagnosed with AEUAT was performed. The charts were reviewed for demographics, etiology, medical history, presentation, physical examination, imaging studies, intervention, and outcome. Findings on FOE as well as other covariants were statistically compared.
Seventy patients with AEUAT were identified. The etiologies consisted of 24 cases of angiotensin converting enzyme inhibitor use (33%), 10 allergic reactions (17%), 1 hereditary (1.5%), and 35 idiopathic cases (48%). Fourteen patients underwent airway intervention, including 6 tracheotomies and 8 intubations. Of the 14 patients, 5 underwent emergent intervention before fiberoptic examination, 4 had laryngeal edema only, and 5 had both laryngeal and base of tongue edema. No patients with both laryngeal and base of tongue edema were observed. The remaining 52 patients were observed in a monitored setting and required no subsequent intervention.
FOE is an invaluable tool in the assessment of the compromised airway in patients with angioneurotic edema Laryngeal edema alone is an ominous physical finding. When laryngeal and pharyngeal edema are present together, the physician should consider immediate intervention. Our findings indicate that symptoms, including stridor, hoarseness, and dysphagia, do correlate with disease severity; however, they must be confirmed with fiberoptic visualization. Although sound clinical judgment should always be exercised, we present our results in the management of the acute airway in angioneurotic edema.
上气道消化道血管性水肿（AEUAT）常常让耳鼻喉科医生面临手术干预还是观察的抉择难题。
制定一种合理的方法来评估和处理AEUAT患者的气道问题，重点关注纤维喉镜检查（FOE）结果。
对所有诊断为AEUAT的患者进行基于计算机的回顾性研究。查阅病历以获取人口统计学信息、病因、病史、临床表现、体格检查、影像学检查、干预措施及结果。对FOE结果及其他相关变量进行统计学比较。
共确定70例AEUAT患者。病因包括24例使用血管紧张素转换酶抑制剂（33%）、10例过敏反应（17%）、1例遗传性（1.5%）和35例特发性病例（48%）。14例患者接受了气道干预，包括6例气管切开术和8例插管。在这14例患者中，5例在纤维喉镜检查前接受了紧急干预，4例仅有喉部水肿，5例同时有喉部和舌根水肿。未观察到同时有喉部和舌根水肿的患者。其余52例患者在监测环境中接受观察，无需后续干预。
FOE是评估血管性水肿患者气道受损情况的一项宝贵工具。单独的喉部水肿是一个不祥的体格检查发现。当喉部和咽部水肿同时出现时，医生应考虑立即进行干预。我们的研究结果表明，包括喘鸣、声音嘶哑和吞咽困难在内的症状确实与疾病严重程度相关；然而，必须通过纤维喉镜可视化来证实。尽管应始终运用合理的临床判断，但我们还是展示了我们在血管性水肿急性气道处理方面的结果。
