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经口气管插管术后患者的塔皮亚综合征

Tapia's syndrome in post-operative patient following orotracheal intubation.

作者信息

Neupane Sandhya Kiran, Poudel Jaishi Prakash, Acharya Aakash, Neupane Prabhat Kiran, Koirala Divyaa, Joshi Kusum

机构信息

Department of Medicine, Shadhak Polyclinic, Bhaktapur, Nepal.

Department of Medicine, Bhakunde Hospital, Kavrepalanchowk, Nepal.

出版信息

Ann Med Surg (Lond). 2022 Jun 23;79:104043. doi: 10.1016/j.amsu.2022.104043. eCollection 2022 Jul.

Abstract

INTRODUCTION

Tapia's syndrome is a rare condition that manifest due to unilateral extracranial nerve extension of cranial nerve 10 and 12 which occurred as a rare complication of Orotracheal Intubation in patient undergoing Laparoscopic appendectomy.

CASE PRESENTATION

A 30 year old male, a known case of normal variant Right bundle branch block and Gilbert syndrome underwent orotracheal intubation prior to general anesthesia for emergency laparoscopic appendectomy. Postoperatively while assessing the patient there was deviation of tongue on left side.

CLINICAL FINDINGS AND INVESTIGATIONS

On examination of throat, atrophic and deviated uvula toward the right side was found. While protruding his tongue, tongue was deviated towards left side.Neurological examination revealed sluggish Gag Reflex. Brain Ct was done, which showed normal scan.

INTERVENTIONS AND OUTCOME

Tablet Prednisolone and logopedic therapy in combination helped in early recovery; which is almost 8 weeks. Patient was completely recovered in 2 month with gradual improvement of phonation, tongue tone and mobility.

RELEVANCE AND IMPACT

The intent of this report is to show how important it is for anesthesia providers and surgeons to understand Tapia's syndrome, its causes, and the fact that it can occur despite seemingly normal airway care and neck posture. We believe that by raising awareness of this uncommon issue, practitioners will be able to early identify this complication.

摘要

引言

塔皮亚综合征是一种罕见疾病,因迷走神经和舌下神经的单侧颅外神经延伸而出现,这是腹腔镜阑尾切除术患者经口气管插管罕见的并发症。

病例介绍

一名30岁男性,已知患有右束支传导阻滞正常变异型和吉尔伯特综合征,在全身麻醉下行急诊腹腔镜阑尾切除术之前接受了经口气管插管。术后评估患者时发现舌头偏向左侧。

临床发现与检查

检查喉咙时,发现悬雍垂萎缩并偏向右侧。患者伸舌时,舌头偏向左侧。神经学检查显示咽反射迟钝。进行了脑部CT检查,扫描结果正常。

干预措施与结果

泼尼松龙片与言语治疗相结合有助于早期恢复,恢复时间约为8周。患者在2个月内完全康复,发声、舌肌张力和活动能力逐渐改善。

相关性与影响

本报告旨在表明麻醉医生和外科医生了解塔皮亚综合征、其病因以及尽管气道护理和颈部姿势看似正常仍可能发生该综合征这一事实的重要性。我们认为,通过提高对这一罕见问题的认识,从业者将能够早期识别这一并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3123/9289403/b90b61cdecbb/gr1.jpg

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