Shimizu Y, Mori E, Wada K, Otori N, Kojima H
B-ENT. 2016;12(4):279-284.
Airway intervention in cases of acute epiglottitis.Problem/objectives: In cases of acute epiglottitis, indications for airway intervention have not been established. In the present study, we reviewed patients with acute epiglottitis to identify clinical factors, which suggest airway intervention should be performed.
Patients with acute epiglottitis admitted to The Jikei University Daisan Hospital (Tokyo) from 2004 to 2013 were identified. Patients' characteristics, histories, laryngoscopic findings and laboratory findings were reviewed and analysed.
Of the 83 patients (82 adults and one adolescent) in the sample, 16 (19%) underwent airway intervention and conservative treatment. The factors that were significantly more likely to have been present in patients who received airway intervention were odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis, less than 50% of the glottis area being visible with laryngoscopy, and a high white blood cell (WBC) count. The only factor that was shown by multiple logistic regression analysis to be distinctively predictive of airway intervention was "less than 50% of the glottis area being visible" (P = .000, odds ratio = 23.630, sensitivity = 86.6%, specificity = 78.6%, predictive accuracy = 85.2%).
When considering whether airway intervention should be performed in cases of acute epiglottitis, the most important clinical factor is the laryngoscopic finding that "less than 50% of the glottis area being visible." Other important clinical factors to consider are odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis and a high WBC count.
急性会厌炎病例的气道干预
问题/目标：在急性会厌炎病例中，气道干预的指征尚未确立。在本研究中，我们回顾了急性会厌炎患者，以确定提示应进行气道干预的临床因素。
确定2004年至2013年入住东京慈惠会医科大学第三医院的急性会厌炎患者。回顾并分析患者的特征、病史、喉镜检查结果和实验室检查结果。
样本中的83例患者（82名成人和1名青少年）中，16例（19%）接受了气道干预和保守治疗。接受气道干预的患者中显著更可能出现的因素有吞咽痛、流涎、声音嘶哑、声音低沉、呼吸困难、会厌后侧肿胀、喉镜检查时声门区可见面积小于50%以及白细胞计数高。多因素逻辑回归分析显示唯一能显著预测气道干预的因素是“声门区可见面积小于50%”（P = .000，比值比 = 23.630，敏感性 = 86.6%，特异性 = 78.6%，预测准确率 = 85.2%）。
在考虑急性会厌炎病例是否应进行气道干预时，最重要的临床因素是喉镜检查结果“声门区可见面积小于50%”。其他需要考虑的重要临床因素有吞咽痛、流涎、声音嘶哑、声音低沉、呼吸困难、会厌后侧肿胀以及白细胞计数高。
