Gould S J, Young M
Maternity Department, John Radcliffe Hospital, Oxford, England.
Ann Otol Rhinol Laryngol. 1992 Oct;101(10):815-20. doi: 10.1177/000348949210101003.
In neonates, acquired subglottic stenosis is the most serious long-term complication of endotracheal intubation and is due primarily to posttraumatic fibrosis of the infant larynx. We have examined 78 larynges, 75 of which were intubated, from infants ranging in gestation from 22 to 40 weeks, and who survived from a few hours to up to 300 days. Each larynx was morphometrically assessed for the extent of acute injury, indicated by the percentage of epithelial loss, and healing, indicated by the percentage of a subglottic ulcer covered by metaplastic squamous epithelium. Results show that acute injury is almost invariable, and up to 100% of the subglottic epithelium may be lost within a few hours of intubation, but that progression of injury is relatively short-lived. Ulcer healing starts after a few days, rapidly progresses from day 10, and in the majority of cases is complete after 30 days. This study suggests that long-standing acute injury in the subglottis is the exception rather than the rule, even with the endotracheal tube remaining in place.
在新生儿中，获得性声门下狭窄是气管插管最严重的长期并发症，主要是由于婴儿喉部创伤后纤维化所致。我们检查了78个喉部，其中75个曾接受插管，这些婴儿的孕周从22周到40周不等，存活时间从几小时到300天。对每个喉部进行形态学评估，以确定急性损伤的程度（通过上皮损失百分比表示）和愈合情况（通过化生鳞状上皮覆盖的声门下溃疡百分比表示）。结果显示，急性损伤几乎是不可避免的，插管后几小时内声门下上皮损失可达100%，但损伤进展相对短暂。溃疡愈合在几天后开始，从第10天迅速进展，大多数情况下在30天后完成。这项研究表明，即使气管导管仍留在原位，声门下长期存在急性损伤也是例外而非普遍现象。
