全身麻醉气管插管患者术后声带运动不良的临床结局

doi:10.19723/j.issn.1671-167X.2021.02.018

摘要/Abstract

摘要：

目的: 分析全身麻醉气管插管患者术后声带运动不良的发生率。方法: 回顾北京大学第一医院2014年1月至2018年12月所有全身麻醉气管插管手术患者的围术期病历资料,分析术后声音嘶哑和声带固定的发生率与临床结局。结果: 5年内共纳入分析85 998例全身麻醉气管插管患者,其中222例(0.26%)发生术后声音嘶哑,29例患者为持续声音嘶哑,经耳鼻喉科医生明确诊断,其中7例为咽喉炎,22例(0.026%)为术后声带固定,左侧声带固定较多见为17例(77%), 右侧声带固定5例(23%)。22例声带固定患者中,9例患者确诊为杓状软骨脱位,其中7例为左侧声带固定,2例为右侧声带固定;7例为可视喉镜引导气管插管,1例为困难气道,在光棒引导下插管,1例为喉罩置入。1例可疑为麻醉前插胃管导致,1例合并左喉返神经功能异常,3例患者给予局部麻醉下闭合复位,1例自行复位缓解,症状持续时间16 d(5~31 d)。其余13例声带固定患者中,2例患者为声带麻痹,11例患者为颈部、甲状腺和心胸手术,未能进一步检查明确病因诊断。所有患者均给予激素雾化等对症治疗,离院时5例症状明显好转或接近正常,1例症状有缓解,16例症状未缓解。结论: 全身麻醉气管插管患者术后出现持续声音嘶哑和声带运动不良者应尽可能及时诊断治疗。

关键词: 气管插管, 声音嘶哑, 术后并发症, 声带运动不良, 杓状软骨脱位

Abstract:

Objective: To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia. Methods: We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed. Results: A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge. Conclusion: Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.

Key words: Endotracheal intubation, Hoarseness, Postoperative complication, Vocal fold immobility, Arytenoid dislocation

中图分类号:

R614.2

耿志宇,高为华,王东信. 全身麻醉气管插管患者术后声带运动不良的临床结局[J]. 北京大学学报（医学版）, 2021, 53(2): 337-340.

GENG Zhi-yu,GAO Wei-hua,WANG Dong-xin. Clinical outcomes of vocal fold immobility after tracheal intubation[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 337-340.

图/表 2

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Characteristic	Value
Gender,male/female	10/12
Age/years	52±11
Height/cm	166.7±8.3
Weight/kg	66.6±13.6
BMI/(kg/m²)	23.9±4.0
Surgical procedure, cardiothoracic/lumbar abdominal/neck	9/8/5
Anesthetic maintenance drugs, TIVA/balanced anesthesia/ N₂O	8/2/12
Type of intubation, ETT/DLT/BO	15/5/1
LMA	1

Case	Age/years	Gender	Duration of EI/min	Side	Symptom/d	Outcome
1	58	Male	360	Left	13	Improved
2	37	Female	435	Right	16	Unchanged
3	58	Female	300	Left	20	Normal
4	56	Female	260	Left	14	Closed reduction, improved
5	37	Female	330	Left	21	Closed reduction, slight improved
6	40	Female	180	Left	6	Unchanged
7	57	Male	200	Right	31	Closed reduction,improved
8	60	Female	720	Left	6	Unchanged
9	21	Female	360	Left	5	Spontaneous reduction