Shafei H, el-Kholy A, Azmy S, Ebrahim M, al-Ebrahim K
Al-Hada Armed Forces Hospital, Taif, Saudi Arabia.
Eur J Cardiothorac Surg. 1997 Mar;11(3):564-6. doi: 10.1016/s1010-7940(96)01068-8.
To evaluate the complication of vocal cord dysfunction following open heart surgery and its short- and long-term effects.
Five cases (1.9%) of vocal cord dysfunction which were diagnosed among 270 cases of adult open heart surgery performed at this centre between February 1993 and May 1995.
All five patients developed respiratory insufficiency following tracheal extubation. They required reintubation and ventilation. Diagnosis was delayed in three cases because of unawareness of the problem. Tracheostomy was performed in three cases and minitracheostomy in two. In one case, shortness of breath on exertion persisted due to partial laryngeal obstruction from bilateral cord paresis and required arytenoidectomy 11 months postoperatively.
Vocal cord dysfunction can be an easily overlooked complication after open heart surgery. It can be the cause of respiratory insufficiency following tracheal extubation and may lead to reintubation and reventilation. The cause of the problem cannot always be traced but it may be due to direct trauma of the vocal cords during tracheal intubation, or trauma of the recurrent laryngeal nerve from the cuff of the endotracheal tube. A less likely possibility is that it may result from nerve injury due to central venous cannulation, or from cold. The condition may resolve within months, but, in rare cases, may lead to permanent morbidity.
评估心脏直视手术后声带功能障碍的并发症及其短期和长期影响。
在1993年2月至1995年5月期间于本中心进行的270例成人心脏直视手术中诊断出5例（1.9%）声带功能障碍。
所有5例患者在气管拔管后均出现呼吸功能不全。他们需要重新插管和通气。3例因对该问题认识不足而诊断延迟。3例行气管切开术，2例行微创气管切开术。1例患者因双侧声带麻痹导致部分喉梗阻，术后11个月仍存在运动时气短，需要行杓状软骨切除术。
声带功能障碍可能是心脏直视手术后一个容易被忽视的并发症。它可能是气管拔管后呼吸功能不全的原因，并可能导致重新插管和再次通气。该问题的原因不一定总能找到，但可能是气管插管时声带直接受创伤，或气管内导管套囊对喉返神经的创伤。可能性较小的原因可能是中心静脉置管导致的神经损伤或寒冷。这种情况可能在数月内缓解，但在罕见情况下可能导致永久性发病。
