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气管插管后喉水肿的延迟发作:兼顾患者自主权与成功的医疗管理

Delayed Onset of Post-Intubation Laryngeal Oedema: Navigating Patient Autonomy and Successful Medical Management.

作者信息

Ramasamy Kuganathan, Teo Davina Stasia Hui Ming, Shakri Nadhirah Mohd

机构信息

Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Shah Alam, Shah Alam, Selangor Malaysia.

Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur, 56000 Malaysia.

出版信息

Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2666-2669. doi: 10.1007/s12070-025-05547-9. Epub 2025 May 16.

Abstract

Post-intubation laryngeal oedema typically manifests early with stridor following extubation. We present a case of a patient who underwent elective surgery for breast malignancy and developed inspiratory stridor approximately 48 h post-extubation. Initial suspicion pointed towards subglottic stenosis; however, the patient opted out of the proposed surgical intervention to address her airway concerns. Thus, medical management was initiated alongside close monitoring, resulting in a successful resolution. This prompted a revised diagnosis of post-intubation subglottic oedema. This case underscores the importance of considering delayed-onset laryngeal oedema as a differential diagnosis for post-extubation stridor, even in the absence of traditional risk factors. It also explores the delicate balance between clinical judgment and respecting patient autonomy.

摘要

插管后喉水肿通常在拔管后早期表现为喘鸣。我们报告一例因乳腺恶性肿瘤接受择期手术的患者,在拔管后约48小时出现吸气性喘鸣。最初怀疑是声门下狭窄;然而,患者选择不接受为解决其气道问题而建议的手术干预。因此,在密切监测的同时开始了药物治疗,最终成功解决。这促使对插管后声门下水肿进行了修正诊断。该病例强调了即使在没有传统危险因素的情况下,也应将迟发性喉水肿作为拔管后喘鸣的鉴别诊断加以考虑的重要性。它还探讨了临床判断与尊重患者自主权之间的微妙平衡。

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