Subglottic Stenosis after Thoracotomy-A Case Report

造成聲門下氣管狹窄之原因，最常見的是外傷性、重複多次插管、不適當管徑之氣管內管及沒有固定好氣管內管造成的傷害。其它系統性疾病原因包括敗血症、低血壓、自體免疫疾病及胃食道逆流。在開胸手術，除了選擇適當管徑之雙腔氣管內管或單腔雙囊支氣管內管(Univent tube)以減少傷害外，有研究報告指出側躺開胸手術較一般手術容易發生胃食道逆流而造成氣管酸性吸入傷害。所以我們認為造成本病例聲門下氣管狹窄是因為外傷性原因（重複氣管插管）、不適當的氣管內管管徑及側躺開胸手術中易造成之胃食道逆流加重因子；我們建議對於側躺開胸手術前已經有胃食道逆流症狀的病人，事先預防性的胃藥治療是必需的。

關鍵字

聲門下氣管狹窄；開胸手術；胃食道逆流；術後併發症；氣管內插管

並列摘要

Traumatic intubation, reintubation, intubation with endotracheal tube of inappropriate size, and failure to firmly secure the tube may contribute to the development of subglottic stenosis. Systemic factors such as sepsis, hypotension, autoimmune and granulomatous disorders have all been implicated as contributing causes. In addition, a risky circumstance that might be considered important in the development of airway damage is the occurrence of gastreoesophageal reflux (GER), particularly in thoracotomy operations, where the patients are placed in the lateral position. The purpose of this report is to describe a patient who developed subglottic stenosis following a thoracotomy. The possible causes are macrotrauma due to multiple intubations and microtrauma due to inappropriate tube size in the course of anesthesia. Furthermore, GER may worsen mucosal injuries, which may be precipitated by the lateral position.

並列關鍵字

Tracheal Stenosis: subglottic ； Thoracotomy ； Gastroesophageal reflux ； Postoperative complications ； Intubation, intratracheal

國際替代計量

Subglottic Stenosis after Thoracotomy-A Case Report

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