拨动复位术治疗气管插管后杓状软骨脱位疗效分析  

Therapeutic effect of reduction on arytenoid dislocation caused by endotracheal intubation

作　　者：孙安科[1] 郭晓红[1] 张铁铮[2] 刘文源[3] 

机构地区：[1]沈阳军区总医院耳鼻咽喉科,辽宁沈阳110016 [2]沈阳军区总医院麻醉科,辽宁沈阳110016 [3]沈阳军区总医院放射诊断科,辽宁沈阳110016

出　　处：《临床军医杂志》2014年第6期605-607,610,共4页Clinical Journal of Medical Officers

摘　　要：目的观察分析杓状软骨拨动复位术治疗气管插管后杓状软骨脱位的疗效。方法 135例气管插管后持续性音哑患者,通过病史、症状、三维CT重建、电子及频闪喉镜检查确诊128例为杓状软骨脱位。根据患者病况分别于气管插管后不同时期在局麻或全麻下行杓状软骨拨动复位术。详细记录术后当时到患者出院时的发音和喉内情况,以后跟踪随访至少2年以上(中间至少进行1次喉内检查),根据满2年随访资料判断远期疗效。结果 128例中局麻下1次杓状软骨拨动复位手术后声带运动及发音改善者64例,2次以上28例。全麻下施术1次声带运动及发音改善者30例,2次以上6例。所有患者出院前发音均基本恢复到气管插管前水平,喉内检查两侧杓状软骨对称,声带运动良好,部分患者喉内黏膜虽仍有不同程度的充血肿胀,但表面光滑。术后随访至少2年,其中2年内死亡11例,失去联系8例,2年后有效随访对象109例;经患者本人及其家人评估发音质量和喉内客观检查,远期疗效均保持或超过出院前水平。结论杓状软骨拨动复位术治疗气管插管所致杓状软骨脱位效果显著,远期疗效稳定。Objective To analyze the therapeutic effect of arytenoid reduction on arytenoid dislocation after endotracheal intubation. Methods Among 135 patients with lasting hoarseness after endotracheal intubation, 128 ones were diagnosed as arytenoid dislocation by medical record, clinical symptoms, three-dimensional spiral CT, stroboscopy and laryngoscopy. Arytenoid reduction was performed under local or whole anesthesia at different period after extnbation according to the patients＇ condition. Therapeutic effect after reduction was record in details including patients＇ voice, vocal fold movement, the condition of mucous membrane, and so on. Then, a follow-up more than 2-year for every patient was carried out for the evaluation of long-term effect （ laryngoscopic examination at least one time at a period of 2 years）. Results Among the 128 patients, 64 and 28 of whom gained improvement in vocal fold movement and vocalization after reduction for once and twice; whole anesthesia was performed, 30 and 6 of whom gained improvement in vocal fold movement and vocalization after reduction for once and twice, respectively. All the patients recovered their voice near the same as that before endotracheal intubation; their bilateral vocal fold and arytenoid were mutually symmetrical and the surface of mucous membrane was smooth despite still remaining mild congestion or swelling in several cases when they left hospital. Two years＇ follow-up demonstrated that 11 patients died, 8 lost contact and 109 had feedback. The data showed that the patients＇ voice and laryngeal condition still kept the same as or beyond the level of records when they left hospital. Conclusion It seems that arytenoid reduction is very useful therapeutic choice for arytenoid dislocation after endotracheal intubation and its long-term effect is fairly stable.

关 键 词：气管插管 杓状软骨 脱位 拨动复位术 

分 类 号：R681.3[医药卫生—骨科学]