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微粉化亞洛登注射喉整形術後發生呼吸道阻塞

Airway Obstruction after Micronized AlloDerm Injection Laryngoplasty

Abstracts


目前最常用於注射喉整形術的材料為自體脂肪組織和自體膠原。微粉化亞洛登(micronized AlloDerm,商品名Cymetra),是美國LifeCell生技公司剛發展出來的喉整形術注射用材料,是一種無細胞的真皮,已為美國藥物食品管理局所認可。其發生併發症的機會低,英文文獻中只有兩起呼吸困難併發症,分別是喉痙攣和矛盾聲帶運動(paradoxical vocal cord movement)。我們提出一例33歲男性因為愛滋病及右側聲帶麻痺而接受微粉化亞洛登注射喉整形術,術後發生急性呼吸困難之罕見案例,處理方法為緊急再度插管及靜脈注射類固醇,最有可能的病因是同時多次的聲帶注射傷口造成嚴重的聲門水腫,壓迫到因注射而窄縮的聲門內徑,導致了延遲性的呼吸困難。 結論:異物注射的風險不容忽視,注射喉整形術本身就會對喉部造成傷害,聲門的發炎水腫在所難免,特別是同時多次注射者就應該要考慮到可能會有進行性的呼吸道阻塞,當考慮延遲拔管;就算是術後順利拔管,還是要留意病患呼吸的狀況並提高警覺,當不幸發生延遲性的呼吸道阻塞時,緊急再度插管及靜脈給予速效型類固醇方可解決這種意外。以光纖喉內視鏡檢查及鬆袖球測試確認病患是否可以再度拔管。拔管後尚須小心地監測病患的呼吸至少24小時後,方可出院。

Parallel abstracts


Currently, the most commonly injected materials for injection laryngoplasty are autologous fat, and collagen. Cymetra (micronized AlloDerm, LifeCell Corporation, U.S.A.), a recently developed and U.S. Food and Drug Administration-approved biomaterial, has been reported a new material that is suitable for injection laryngoplasty. Its complication rate was low, except two cases of acute airway obstruction has been reported laryngospasm and paradoxical vocal cord movement. A 33-year-old male patient received micronized AlloDerm injection laryngoplasty because of acquired immunodeficiency syndrome and right-sided vocal cord palsy. A irway obstruction happened to him after extubation. Then he received reintubation and intravenous steroids immediately. We inferred that this injection laryngoplasty caused simultaneous multiple trauma of vocal cords, then delayed glottic edema developed and threatened the post-injected glottic lumen. In conclusion, foreign body reaction should not be negligible, and inflammatory edematous swelling of glottis is expected after injection laryngoplasty. Delayed extubation is recommended if airway obstruction is pending. Close follow-up is crucial after extubation. Immediate re-intubation and intravenous steroids could solve airway obstruction from glottic edema. Only fiberoptic laryngoscope and cuff-leak test can promise safe re-extubation. Follow up will be permitted at out-patient-department after respiration has been monitored uneventful at least 24 hours.

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