Analysis of Bronchoscopic Findings in Patients Suspected of Having Upper Airway Obstruction

疑有上呼吸道阻塞病患之支氣管鏡檢查結果分析

方文豐(Wen-Feng Fang) ； 吳沼漧(Chao-Chien Wu) ； 王逸熙(Yi-Hsi Wang) ； 吳自成(Tzu-Cheng Wu) ； 賴永發(Young-Fa Lai) ； 王瑞隆(Sui-Liong Wong)

《胸腔醫學》 18卷5期 (2003/10) Pp. 402-408

https://doi.org/10.29806/TM.200310.0003

摘要

前言：很多侵犯鼻咽至氣管隆凸間呼吸道的狀況會造成上呼吸道阻塞。及早診斷出上呼吸道阻塞是很重要地，因為它可能會導致嚴重的呼吸問題甚至呼吸衰竭。本文目的在探討於疑有上呼吸道阻塞病患之支氣管鏡檢查結果分析。
材料與方法：我們回溯性分析自從1998年2月到2003年3月間，在高雄長庚紀念醫院因為疑似有上呼吸道阻塞之病患而來接受支氣管鏡檢查之檢查結果，一共有108位病患。並且由病歷中分析其相關資料。
結果：支氣管鏡檢查有所發現者超過八成。最常見之症狀或徵兆為呼吸困難，其次為喘鳴。最常見之阻塞部位在氣管，其次在聲帶。最常見之病因是因為曾經接受氣管內插管，或氣管造口術之氣管狹窄後遺症（佔50.3%）。然而，在年齡、性別、氣管狹窄之比率、接受氣管內插管之原因、氣管狹窄之形狀、接受氣管內插管和接受支氣管鏡檢查之時距上並無相關性存在。我們也注意到其他造成上呼吸道阻塞的病因，例如因為腫瘤而導致聲帶麻痺等等。
結論：對於抱怨會喘的病患，我們應該常常保持警覺性，看看病患是否有上呼吸道阻塞。當病患有上呼吸道阻塞的可能性時，品質良好的胸部X光並且仔細判讀可以幫助提早診斷。

關鍵字

上呼吸道阻塞 ； 支氣管鏡術 ； 喘鳴

並列摘要

Background: A great variety of the conditions affecting the upper airway from the nasopharynx to the tracheal carina can cause upper airway obstruction (UAO). It is important to make an early diagnosis of UAO, because it may lead to severe respiratory problems or respiratory failure. The purpose of this study is to explore the bronchoscopic findings in patients suspected of having upper airway obstruction.
Materials and Methods: We retrospectively analyzed a series of 108 patients with suspected UAO who had undergone bronchoscopic examination from February 1998 to March 2003 at Kaohsiung Chang Gung Memorial Hospital. The medical records of these patients were subsequently reviewed.
Results: The overall positive rate of the bronchoscopic findings exceeded 80%. The most frequent symptom or sign was dyspnea, followed by stridor. The most common obstruction location was the trachea, followed by the vocal cord. The most common etiology was tracheal stenosis as a complication of translaryngeal intubation or tracheostomy (50.3%). However, no relationship among gender, age, percentage of stenosis, indication for intubation, type of stenosis, and length of time between intubation and bronchoscopy was noted. We also found other etiologies of UAO, such as a neoplasm causing vocal cord paralysis.
Conclusions: We need frequently to remind ourselves of the possibility of UAO in every patient complaining of dyspnea. Chest roentgenograms of good quality interpreted with a high degree of suspicion, particularly when the patient has the risk of UAO, will lead to earlier diagnosis.

並列關鍵字

upper airway obstruction ； bronchoscopy ； stridor