Shapira Galitz Yael, Shoffel-Havakuk Hagit, Cohen Oded, Halperin Doron, Lahav Yonatan
Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel, affiliated with the Hebrew University of Jerusalem, Israel.
USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A.
Laryngoscope. 2017 Sep;127(9):2106-2112. doi: 10.1002/lary.26609. Epub 2017 May 11.
OBJECTIVES/HYPOTHESIS: Acute supraglottitis is a potentially life-threatening condition due to rapid onset upper airway obstruction. The study aimed to characterize adult acute supraglottitis patients and to recognize factors associated with an aggressive disease course.
Retrospective chart review.
All adult acute supraglottitis patients admitted to a single academic medical center between 2000 and 2014 were included and their medical charts reviewed. The main outcome measures were airway intervention and mortality.
Three hundred fifty-eight patients were enrolled. Mean age was 53 years (range, 16-92 years), with 62.8% males. Sore throat (79%) and dysphagia (70.9%) were the most common symptoms. Stridor (3.6%), tachypnea (5.7%), and dyspnea (6.4%) were uncommon but significantly associated with airway intervention. The epiglottis was most commonly involved (67%). Involvement of the epiglottis and aryepiglottic folds showed a trend of correlation to airway intervention. Blood glucose levels, C-reactive protein (CRP) levels, and relative neutrophilia were significantly higher in patients admitted to the intensive care unit or requiring airway intervention. Thirty-four patients (9.5%) required intensive care unit admission. Sixteen patients (4.4%) required airway intervention. Recurrent episodes of supraglottitis, seen in 19 patients, were more common in males (P = .048), and tended to have a more severe clinical course, requiring more airway interventions (P = .005) and intensive care unit admissions (P = .016).
The typical high risk patient-a male, with dyspnea and stridor, presenting with edema of the epiglottis and aryepiglottic folds, elevated CRP, hyperglycemia, and a history of recurrent episodes-should warrant more aggressive treatment and closer observation.
4 Laryngoscope, 127:2106-2112, 2017.
目的/假设：急性会厌炎是一种因上呼吸道迅速梗阻而可能危及生命的疾病。本研究旨在描述成年急性会厌炎患者的特征，并识别与侵袭性病程相关的因素。
回顾性病历审查。
纳入2000年至2014年间入住单一学术医疗中心的所有成年急性会厌炎患者，并对其病历进行审查。主要观察指标为气道干预和死亡率。
共纳入358例患者。平均年龄为53岁（范围16 - 92岁），男性占62.8%。咽痛（79%）和吞咽困难（70.9%）是最常见的症状。喘鸣（3.6%）、呼吸急促（5.7%）和呼吸困难（6.4%）虽不常见，但与气道干预显著相关。会厌最常受累（67%）。会厌和声襞受累与气道干预呈相关趋势。入住重症监护病房或需要气道干预的患者血糖水平、C反应蛋白（CRP）水平及相对中性粒细胞增多更为显著。34例患者（9.5%）需要入住重症监护病房。16例患者（4.4%）需要气道干预。19例患者出现复发性会厌炎，男性更为常见（P = 0.048），且临床病程往往更严重，需要更多的气道干预（P = 0.005）和重症监护病房入住率（P = 0.016）。
典型的高危患者——男性，伴有呼吸困难和喘鸣，出现会厌和声襞水肿，CRP升高，血糖升高，并有复发史——应接受更积极的治疗和密切观察。
4 《喉镜》，127:2106 - 2112，2017年
