Apostolakis L W, Funk G F, Urdaneta L F, McCulloch T M, Jeyapalan M M
Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City 50242, USA.
Head Neck. 2001 Jan;23(1):59-63. doi: 10.1002/1097-0347(200101)23:1<59::aid-hed9>3.0.co;2-a.
The nasogastric tube syndrome is a potentially life-threatening complication of an indwelling nasogastric (NG) tube. The syndrome is thought to result from ulceration and infection of the posterior cricoid region with subsequent dysfunction of vocal cord abduction. This dysfunction may present as complete loss of vocal cord abduction manifested as serious airway compromise. Reports of this syndrome are infrequent, with only 29 cases published to date.
Two additional cases of nasogastric tube syndrome diagnosed at the University of Iowa Hospitals and Clinics over a 2-year period are presented. A search of MEDLINE (1966 through February 1999), including review of those articles' references identified seven previous publications, including 29 case reports. These 29 cases are reviewed and the findings summarized.
Twenty-nine cases of NG tube syndrome are identified, with 16 of these occurring in the preantibiotic period. Including the two cases presented here, 15 contemporary patients are examined. Among these 15 cases, 10 required tracheostomy, on average 8.5 days after NG tube placement.
Although the fully manifested syndrome presents quite dramatically, we suspect that a clinical spectrum of severity exists with less severe cases going unrecognized. Consistent with previous reports, we found that direct visualization of the postcricoid region is required to rule out the diagnosis and recommend such action be taken whenever the diagnosis is suspected. Treatment should include establishment of a safe airway, removal of the tube whenever possible, antibiotic therapy, and antireflux therapy.
鼻胃管综合征是留置鼻胃管可能危及生命的并发症。该综合征被认为是由于环状软骨后区域溃疡和感染，随后声带外展功能障碍所致。这种功能障碍可能表现为声带外展完全丧失，导致严重的气道受损。关于该综合征的报道并不常见，迄今为止仅发表了29例。
介绍了在爱荷华大学医院及诊所2年期间诊断出的另外2例鼻胃管综合征病例。检索MEDLINE（1966年至1999年2月），包括查阅这些文章的参考文献，共确定了7篇先前的出版物，其中包括29例病例报告。对这29例病例进行了回顾并总结了研究结果。
共确定了29例鼻胃管综合征病例，其中16例发生在抗生素使用前时期。包括本文介绍的2例，对15例当代患者进行了检查。在这15例病例中，10例需要行气管切开术，平均在放置鼻胃管后8.5天。
尽管完全表现出的综合征症状非常明显，但我们怀疑存在严重程度不同的临床谱，较轻的病例未被识别。与先前的报道一致，我们发现需要直接观察环状软骨后区域以排除诊断，并建议在怀疑诊断时采取此类措施。治疗应包括建立安全气道、尽可能拔除鼻胃管、抗生素治疗和抗反流治疗。
