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氣管插管後延遲性單側聲帶運動不良及肉芽腫

Delayed Unilateral Vocal Fold Immobility and Granuloma Following Endotracheal Intubation

Abstracts


成人患者接受氣管插管治療後,偶而會出現喉部病變。本文報告一57歲家庭主婦,曾因敗血性休克合併多重器官衰竭於本院加護中心接受氣管插管治療共計3日。拔管後1週,喉部理學檢查並無異常發現。但是,1個月後開始出現聲音沙啞及說話容易累等症狀。理學檢查發現左側聲帶運動不良及肉芽腫。保守治療2個月後,這些喉部病症依然沒有改善,遂建議喉部直達鏡顯微手術切除聲帶肉芽腫。左側聲帶運動不良在術後2個月才消失。往後半年,情況依然穩定,並無復發聲帶運動不良或肉芽腫。因此,在加護中心接受氣管插管治療後,即便拔管後無喉部病症或病變,仍有可能在1個月後出現「延遲性」聲帶運動不良及肉芽腫,密切追蹤有其必要。

Parallel abstracts


Adult patients who undergo endotracheal intubation occasionally suffer laryngeal abnormalities. A 57-year-old female housewife had received three days ICU intubation due to septic shock with multiple organ failure. A laryngeal examination did not show any abnormal findings at one week after extubation. However, one month later, she was bothered by husky hoarseness and easy vocal fatigue. A physical examination showed the presence of left vocal fold immobility and granuloma. Two months of conservative treatment failed to cure the symptoms and therefore microlaryngeal surgery was recommended to excise the vocal granuloma. After this, the left vocal fold immobility was found to have remitted after two months of postoperative recovery. The following six months was uneventful, and there has been no recurrence of vocal palsy or granuloma. Therefore, although no laryngeal symptom or abnormality were found after extubation, it would seem that delayed vocal fold immobility and granuloma may still occur at up to one month after tube removal among patients who have undergone ICU intubation. Therefore close follow up is recommended for all patients who undergo intubation.

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