Paradoxical Vocal Cord Motion in a Patient with Post-extubation Stridor

因聲帶異常運動造成的拔管後喘鳴

陳信均(Shin-Chun Chen) ； 許嘉鎂(Chia-Mei Hsu) ； 許舒嵐(Shu-Lan Hsu) ； 李彥憲(Yen-Hsien Lee) ； 范國聖(Kuo-Sheng Fan) ； 賴俊良(Chun-Liang Lai)

《胸腔醫學》 26卷4期 (2011/08) Pp. 202-207

https://doi.org/10.29806/TM.201108.0004

摘要

拔管後的喘鳴常造成呼吸器脫離的失敗，最常造成的原因是聲帶的水腫及麻痺。聲帶異常運動(paradoxical vocal fold motion)是由於吸氣或呼氣時，負責聲帶內收的肌肉不正常活動所引起。臨床上常被誤診為氣喘發作等其他問題。本病例是一位62歲男性，因聲帶麻痹及急性呼吸衰竭而入院，拔管後發生喘鳴。藉由支氣管鏡檢查及特殊典型的肺功能量計圖形而確定診斷為聲帶異常運動。

關鍵字

拔管 ； 聲帶異常運動 ； 肺功能量計 ； 聲帶功能異常

並列摘要

Post-extubation stridor frequently causes weaning failure in mechanically ventilated patients. The most common causes of post-extubation stridor are vocal cord edema and paralysis. Paradoxical vocal fold motion (PVFM) is a laryngeal disorder characterized by inappropriate adduction of the vocal cords during inspiration, expiration, or both. Clinically, this disorder is often misdiagnosed as an asthma attack but rarely is it associated with postextubation stridor. A 62-year-old man with vocal cord paralysis and acute respiratory failure developed post-extubation stridor and was identified as having PVFM. We present the typical findings on bronchoscopy. The characteristic patterns of spirometry, including notching and a flattened or truncated flow-volume loop, are also described.

並列關鍵字

extubation ； paradoxical vocal fold motion ； spirometry ； stridor ； vocal cord dysfunction