Steroid on Laryngeal Edema in Prolonged Intubation Observed by Repeated Cuff Leak Tests-a Case Report

以Cuff Leak Test觀察類固醇對長期插管造成之喉部水腫之效果－病例報告

呂云傑(Yun-Chieh Lu) ； 李琳(David Lin Lee)

《東港安泰醫護雜誌》 11卷4期 (2005/12) Pp. 207-213

https://doi.org/10.7078/TSMHMNJ.200512.0207

摘要

拔除氣管內管併發喉部水腫會引起喘鳴，甚至於呼吸衰竭。Cuff leak test已被報告為一有助於預測拔管後喘鳴的方法。而類固醇，研究顯示有助於預防兒童拔管後喘鳴的發生，但在成人則僅有少數報告，且其效用仍未確立。
我們提出一位七十一歲女性病例，因中風及肺炎導致呼吸衰竭，並於拔除氣管內管後併發喉部水腫及呼吸衰竭，因而需要長時間插管。家屬因地方習俗而拒絕氣管造口手術。對此一病患，我們以一系列cuff leak test 觀察發現，當靜脈注射solu-cortef劑量加至每六小時一百毫克時，cuff leak將顯著增加，且此一增加於類固醇停止給予後回復。我們發現此為一全新的方法用以系列觀察喉部水腫嚴重程度之變化，及類固醇對插管造成之喉部水腫之效用。惟仍需更多病例以驗證此一觀察結果。

關鍵字

喉部水腫 ； 類固醇 ； cuff leak test

並列摘要

Post-extubation laryngeal edema may induce stridor and even reintubation. Cuff leak test has been reported as a valuable method to predict post-extubation laryngeal stridor. Steroid has been reported to contribute to the prevention of post-extubation laryngeal edema in children. However, the studies for adults were scanty and the result remains controversial.
We report a 71 year-old female who was admitted due to cerebrovascular accident with dementia. She suffered acute respiratory failure due to pneumonia. She experienced extubation failure due to laryngeal edema. Her family refused early tracheostomy due to local custom. Therefore we had a rare chance to observe the course of laryngeal edema after prolonged intubation and its relationship with steroid dosage. We found an interesting trend of increase of cuff leak when the dose of steroid was added to intravenous solu-cortef 100 mg per 6 hours and decrease after the steroid was discontinued. This is a new method to make series observation of the severity of laryngeal edema and under the arrangement we can see how much dose and how long of duration of the treatment with steroid may improve laryngeal edema. However, the suitable case is rare and further studies may need the cooperation of multiple hospitals.

並列關鍵字

laryngeal edema ； steroid ； cuff leak test