Endoscopic Survey of Post-Extubation Stridor in Children

小兒氣管插管拔管後喘鳴的內視鏡評估

林嘉德(Chia-Der Lin) ； 鄭元凱(Yuan-Kai Cheng) ； 張正成(Jeng-Sheng Chang) ； 林鴻志(Hung-Ji Lin) ； 蘇百弘(Bai-Horng Su) ； 蔡銘修(Ming-Hsui Tsai)

《Acta Paediatrica Taiwanica》 43卷2期 (2002/04) Pp. 91-95

https://doi.org/10.7097/APT.200204.0091

摘要

近二十年來，氣管插管技術、器械及插管材質的進步，使得伴隨氣管插管的合併症已逐漸降低，其主要合併症在於插管後的喉氣管病變。對於伴隨氣管插管的喉氣管病變以往多只參攷國外的研究資料與結果，台灣地區尚無完整的本土性資料。於是利用目前進步的小兒喉氣管內視鏡，觀察嬰幼兒與小兒氣管插管後的實際喉氣管變化情形。自民國87年7月到民國89年9月臆，選擇拔管後喘鳴或難以拔近的小兒患者30名；男性20名，女性10名，以內視鏡評估其呼吸道。結果：插管後喉氣管病變的範圍以喉部病變最多。分析這類患者呼吸道阻塞的原因：19名與插管後喉氣管病變有關；6名有特殊的呼吸道疾病，如軟喉症、聲帶痳痺等；5名主要與神經肌肉疾病引起的舌頭後墜、咽喉氣管協調失常或順順噹當吞嚥不良而淤積在咽喉部位有關。插管後的喉管部病變應稱爲“插管性喉氣管炎”較爲恰當，其變化可由輕微水腫、潰瘍到嚴重的肉芽形成或甚至喉氣管狹窄。引起的原因可以說是喉氣管的褥瘡，主要病變區域包括：聲門後區的vocal process, posterior commissure及聲門下區域。部分小兒氣管插管後喘鳴並不是單純由於氣管插管所引起，可能與其他呼吸道病竈或與患者的全身性疾病，特別是神經系統疾病有關。

關鍵字

氣管插管 ； 喘鳴 ； 內視鏡

並列摘要

Endotracheal intubation is an important airway procedure in the management of neonates and infants. Prolonged intuhation may result in severe laryngeal injury which may lead to chronic laryngeal disability. The nature and causes of post-extubation airway obstruction were evaluated with videoendoscopy. From June 1998 to September 2000, detailed videoendoscopic examination of pediatric airway was performed in 30 children who had persistent stridor after endotracheal extubation or failure of elective extubation. Common locations of post-extubation lesion are the posterior glottis and subglottis. Retrospective analysis of the causes of stridor included: (1) isolated intubation laryngotracheitis(n=19), (2) intubation laryngotracheitis with neuromuscular dysfunction which resulted in tongue drop, laryngotracheal incoordination, saliva pooling over the larynx or poor cough reflex(n=5), and (3) specific airway problems such as laryngomalacia, subglottic stenosis or vocal paralysis(n=6). We favored the term of “intubation laryngotracheitis” instead of “intubation injury” or “intubation trauma”. Although most cases of intubation laryngotracheitis heal, leaving a normal or near-normal larynx, some of them still suffer from airway obstruction after endotracheal extubation. Specific airway problems such as severe laryngomalacia or vocal cords paralysis and neurogenic defects should also be taken into consideration.

並列關鍵字

endoscopy ； intubation ； stridor