Benjamin Bruce
Ear, Nose and Throat Department, Royal North Shore Hospital, and the Ear, Nose and Throat Department, Royal Alexandra Hospital for Children, Sydney, Australia.
Ann Otol Rhinol Laryngol. 2018 Aug;127(8):492-507. doi: 10.1177/0003489418790348.
Laryngeal trauma from prolonged endotracheal intubation occurs in patients of all ages. Most changes are superficial and heal quickly. Injuries that are found consistently during intubation include nonspecific changes, edema, granulation tissue, ulceration, and othermiscellaneous injuries. In thispapersignificant, severe, and lasting trauma of the larynx has been classified on thebasis of theknown factors in pathogenesis, observations made atendoscopy, and photographic documentation. This classification has required introduction of new descriptive terminology: "tongues of granulation tissue," "ulcerated troughs," "healed furrows," and "healed fibrous nodule." During intubation the degree of injury can be precisely assessed under general anesthesia by using telescopes for image magnification, thus assisting adecision whether to continue intubation orperform tracheotomy to minimize long-term morbidity. Changes that are found after extubation result from granulation tissue, ulceration, ora combination of both and have been illustrated on flow charts; a knowledge and understanding of these sequelae allows them to be identified by both indirect and direct laryngoscopy so that treatment can be planned.
长时间气管插管引起的喉创伤可见于各年龄段患者。多数改变为浅表性，愈合迅速。插管过程中持续出现的损伤包括非特异性改变、水肿、肉芽组织、溃疡及其他各种损伤。本文根据已知的发病机制因素、内镜观察结果及摄影记录，对严重且持久的喉部创伤进行了分类。这种分类需要引入新的描述性术语：“肉芽组织舌”“溃疡沟”“愈合沟”和“愈合纤维结节”。插管期间，可在全身麻醉下使用望远镜放大图像精确评估损伤程度，从而辅助决定是继续插管还是行气管切开术，以尽量减少长期发病率。拔管后出现的改变是由肉芽组织、溃疡或两者共同作用引起的，并已在流程图中说明；了解这些后遗症有助于通过间接喉镜和直接喉镜检查识别它们，从而制定治疗方案。
