[气管插管后声带麻痹的临床结局]
[Clinical outcomes of vocal fold immobility after tracheal intubation].
作者信息
Geng Z Y, Gao W H, Wang D X
机构信息
Department of Anesthesiology, First Hospital, Peking University, Beijing 100034, China.
Department of Otolaryngology-Head and Neck Surgery, First Hospital, Peking University, Beijing 100034, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Sep 3;53(2):337-340. doi: 10.19723/j.issn.1671-167X.2021.02.018.
OBJECTIVE
To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.
METHODS
We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.
RESULTS
A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.
CONCLUSION
Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
目的
评估全身麻醉下行气管插管患者术后声带麻痹的发生率。
方法
我们回顾性纳入了2014年1月至2018年12月在北京大学第一医院接受全身麻醉下气管插管手术的患者。收集声音嘶哑和声带固定患者的人口统计学和治疗数据。呈现术后声音嘶哑和声带固定的发生率，并进一步分析临床结局。
结果
本研究共纳入85998例气管插管全身麻醉患者。术后222例（0.26%）出现声音嘶哑。16例（73%）患者有饮水呛咳、发音障碍和咽痛症状。术后第3天仍持续声音嘶哑的29例患者需要耳鼻喉科医生进一步治疗。其中，7例患者患有咽炎，22例（0.026%）患者出现术后声带麻痹。左侧声带固定17例（77%），右侧声带固定5例（23%）。9例患者被诊断为杓状软骨脱位。左侧声带固定7例，右侧声带固定2例。7例患者在可视喉镜引导下插管。1例患者确诊为困难气道，使用光棒插管。1例患者插入喉罩气道。1例患者术前怀疑因胃管导致声音嘶哑。1例患者喉肌电图结果显示同时存在左侧喉返神经异常。声音嘶哑症状持续6至31天。3例患者在局部麻醉下行手法复位，1例患者自行恢复。其余13例声带麻痹患者中，2例被诊断为声带麻痹。11例患者接受了颈部手术、甲状腺手术和心胸外科手术，未进一步进行包括喉肌电图和计算机断层扫描在内的检查以明确诊断。所有患者均接受吸入性糖皮质激素保守治疗。5例患者症状明显改善，声音几乎恢复正常。1例患者稍有改善，16例患者出院前未缓解。
结论
气管插管后出现声音嘶哑和声带活动障碍的患者应及时、妥善治疗。
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