- 期刊
成人急性會厭軟骨炎併上呼吸道阻塞
Acute Epiglottitis with Upper Airway Obstruction in an Adult
摘要
急性會厭軟骨炎可以是一種猛爆性具生命威脅的疾病，較常發生於成人，但也可能發生在任何年齡的病人。如果沒有高度的警覺心、早期診斷，並早期給予適當的治療：包括建立呼吸道，便可能產生嚴重的併發症，甚至死亡。本部於2001年9月在急診經歷一名成人急性會厭軟骨炎病例。病人來時以喉嚨疼痛和吞嚥疼痛為主訴，並無呼吸急促及喘鳴，其症狀與一般急性咽炎無異，唯一較為特殊處，在於病人的姿勢。病患來時採取坐姿，頭部上仰張口呼吸，雙手向後支撐身體，姿勢僵硬且固定不動。我們由此一特殊姿勢、臨床症狀及頸部軟組織攝影，高度懷疑病人罹患急性會厭軟骨炎。而後病人於接受間接喉鏡檢查時，突然發生上呼吸道阻塞併呼吸中止及發紺現象，經給予100%氧氣並於床邊施行氣管造口術，方解救病人性命。其後病人住院接受靜脈抗生素及類固醇治療後，成功拔管並完全康復。
並列摘要
Acute epiglottitis can be a life-threatening disease with a fulminant course, affecting not only adults, but children as well. Early diagnosis and treatment, especially airway management, is crucial if life-threatening complications are to be prevented. A 27 year-old man complaining of a sore throat and odynophagia over the preceding few hours attended the ER. The patient's symptoms were similar to those described in acute pharyngitis, except that the patient was sitting with his head elevated and he was mouth breathing. His clinical symptoms, presentation and lateral neck soft tissue X-ray made acute epiglottitis likely. While undergoing indirect laryngoscopy, sudden upper airway obstruction developed, causing apnea and cyanosis. A laryngoscopy was successfully performed and O2 (FiO2 100%) was given. The patient was then admitted for intravenous antibiotics and corticosteroids. The patient completely recovered and was discharged three days later after successful decannulation.