From the Department of Anaesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Eur J Anaesthesiol. 2017 Jul;34(7):425-431. doi: 10.1097/EJA.0000000000000648.
Vocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur.
To evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors.
Single-centre retrospective review of adult patients.
Osaka University Hospital, Suita, Japan, from January 2013 to August 2015.
We included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases.
The incidence and severity of VCP after extubation.
The incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P < 0.001) and ventricular assist device implantation (OR 3.460, P = 0.005) were independent predictors for VCP.
The identification of these risk factors may facilitate screening for VCP before extubation and possibly help anaesthesia personnel to be prepared to treat VCP-related airway obstruction should it occur.
声带麻痹（VCP）是心胸心血管手术的罕见并发症。在严重的情况下，可能会发生危及生命的气道阻塞。
评估在接受心胸心血管手术的患者中 VCP 的发生率和严重程度，并确定可能的危险因素。
对来自日本大阪大学医院的成人患者进行单中心回顾性研究。
日本大阪大学医院，2013 年 1 月至 2015 年 8 月。
我们最终纳入了 688 例患者。从病历中收集了术前、术中及术后数据。排除了术前存在 VCP 或拔管前气管切开的患者。根据以下分类评估 VCP 严重程度与功能恢复的关系：无；轻度，6 个月时缓解；中度，6 个月时有部分或持续 VCP；或重度，拔管后气道阻塞需要再次插管。所有 VCP 病例均由耳鼻喉科医生诊断。
拔管后 VCP 的发生率和严重程度。
VCP 的发生率（例数）为 4.7%（32 例），其中轻度、中度和重度 VCP 的发生率分别为 1.7%（12 例）、1.5%（10 例）和 1.5%（10 例）。与无 VCP 的患者相比，重度 VCP 患者的 ICU 住院时间明显延长[12.5 天（四分位距 5.5 至 25.5）比 3 天（四分位距 2 至 5），P=0.0002]。在多变量分析中，2 型糖尿病（优势比 1.853，P=0.009）、插管时间（每 24 小时 1.136，P=0.014）、升主动脉弓手术伴头臂干重建（优势比 8.708，P<0.001）和心室辅助装置植入（优势比 3.460，P=0.005）是 VCP 的独立预测因子。
识别这些危险因素可能有助于在拔管前筛查 VCP，并可能有助于麻醉人员在发生 VCP 相关气道阻塞时做好治疗准备。
