Gould S J, Howard S
J Pathol. 1985 Aug;146(4):301-11. doi: 10.1002/path.1711460403.
Subglottic stenosis is the most common serious complication of endotracheal intubation in the neonate with an incidence of between 1-8 per cent. While considered a complication of traumatic injury to the larynx and possibly associated with prolonged intubation, the pathogenesis is poorly understood and the pathology has not been described in detail. The nature of intubation induced injury has been investigated by examining step-sections of 43 larynges removed from neonates post-mortem who had been intubated for periods ranging from 10 min to 12 weeks. Focal ulceration was identified in the supraglottis and the anterior glottis. Similar injury was seen in the posterior glottis and subglottis but with more prolonged intubation there was full thickness mucosal necrosis, perichondritis and partial destruction of the arytenoid and cricoid cartilages. Although the severity of the injury progressed with time and many of the most severe injuries occurred early, in the second and third weeks of intubation, the larynx usually healed despite the continued presence of the endotracheal tube. Prolonged intubation on its own does not appear to be an important factor in the production of severe laryngeal injury nor, therefore, the subsequent complications such as subglottic stenosis.
声门下狭窄是新生儿气管插管最常见的严重并发症，发病率在1%至8%之间。虽然它被认为是喉部创伤性损伤的并发症，可能与长时间插管有关，但其发病机制尚不清楚，病理也未得到详细描述。通过检查43例死后从新生儿身上取下的喉部连续切片，对插管引起的损伤性质进行了研究，这些新生儿的插管时间从10分钟到12周不等。在声门上区和前声门发现了局灶性溃疡。在后声门和声门下也观察到类似损伤，但插管时间延长时会出现全层黏膜坏死、软骨膜炎以及杓状软骨和环状软骨的部分破坏。尽管损伤的严重程度随时间进展，许多最严重的损伤发生在插管后的第二和第三周，但尽管气管导管仍在，喉部通常仍会愈合。长时间插管本身似乎不是导致严重喉部损伤的重要因素，因此也不是随后诸如声门下狭窄等并发症的重要因素。
