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

表1

表2

参考文献 20

[1]	Yamanaka H, Hayashi Y, Watanabe Y, et al. Prolonged hoarseness and arytenoid cartilage dislocation after tracheal intubation[J]. Br J Anaesth, 2009,103(3):452-455. pmid: 19556269
[2]	Lee JY, Sim WS, Kim ES, et al. Incidence and risk factors of postoperative sore throat after endotracheal intubation in Korean patients[J]. J Int Med Res, 2017,45(2):744-752. doi: 10.1177/0300060516687227 pmid: 28173712
[3]	Rubin AD, Hawkshaw MJ, Moyer CA, et al. Arytenoid cartilage dislocation: a 20-year experience[J]. J Voice, 2005,19(4):687-701. pmid: 16301111
[4]	程丽宇, 徐文, 李赟, 等. 声带麻痹与环杓关节脱位临床特征分析[J]. 听力学与言语疾病杂志, 2015,23(4):367-371.
[5]	黄芳, 邵俊. 杓状软骨脱位的诊治进展[J]. 中国眼耳鼻喉科杂志, 2016,16(5):361-364.
[6]	Szigeti CL, Baeuerle JJ, Mongan PD. Arytenoid dislocation with lighted stylet intubation: case report and retrospective review[J]. Anesth Analg, 1994,78(1):185-186. pmid: 8267162
[7]	Hung KC, Hsieh SW. Potential mechanism of arytenoid dislocation following insertion of a calibrating orogastric tube[J]. J Clin Anesth, 2016,31:173-174. pmid: 27185703
[8]	Afonso A, Woo P, Reed A. Arytenoid dislocation following upper gastrointestinal endoscopy[J]. Endoscopy, 2011,43(Suppl 2):E368.
[9]	Ma XX, Fang XM. Severe hoarseness associated with the streamlined liner of the pharyngeal airway (SLIPATM)[J]. Acta Anaesthesiol Scand, 2015,59(4):531-535. pmid: 25656482
[10]	Nerurkar N, Chhapola S. Arytenoid subluxation after a bout of coughing: a rare case[J]. Am J Otolaryngol, 2012,33(2):275-278. doi: 10.1016/j.amjoto.2011.07.001 pmid: 21840624
[11]	Okazaki Y, Ichiba T, Higashi Y. Unusual cause of hoarseness: Arytenoid cartilage dislocation without a traumatic event[J]. Am J Emerg Med, 2018,36(1):172. pmid: 29066184
[12]	虞鹏程, 高楠, 李旭茂, 等. 喉肌电图在声带麻痹与环杓关节脱位疾病中的鉴别价值[J]. 临床耳鼻喉头颈外科杂志, 2018,32(6):420-423.
[13]	Lou Z, Lin Z. The appropriate time for closed reduction using local anesthesia in arytenoids dislocation caused by intubation: a clinical research[J]. Acta Otolaryngol, 2017,137(3):331-336. pmid: 28225317
[14]	Lee SW, Park KN, Welham NV. Clinical features and surgical outcomes following closed reduction of arytenoids dislocation[J]. JAMA Otolaryngol Head Neck Surg, 2014,140(11):1045-1050. doi: 10.1001/jamaoto.2014.2060 pmid: 25257336
[15]	Xu W, Han D, Hu R, et al. Characteristics of vocal fold immobi-lity following endotracheal intubation[J]. Ann Otol Rhinol Laryngol, 2012,121(10):689-694. pmid: 23130546
[16]	Tsuru S, Wakimoto M, Iritakenishi T, et al. Cardiovascular operation: a significant risk factor of arytenoid cartilage dislocation/subluxation after anesthesia[J]. Ann Card Anaesth, 2017,20(3):309-312. pmid: 28701595
[17]	Lou Z, Yu X, Li Y, et al. BMI May be the risk factor for arytenoid dislocation caused by endotracheal intubation: a retrospective case-control study[J]. J Voice, 2018,32(2):221-225. pmid: 28601417
[18]	Donati F, Plaud B. Tracheal intubation: optimal conditions, vocal cord damage, and allergy[J]. Can J Anaesth, 2008,55(10):663-669. pmid: 18835963
[19]	Hockey CA, van Zundert AA, Paratz JD. Does objective measurement of tracheal tube cuff pressures minimise adverse effects and maintain accurate cuff pressures? A systematic review and meta-analysis[J]. Anaesth Intensive Care, 2016,44(5):560-570. pmid: 27608338
[20]	Liu J, Zhang X, Gong W, et al. Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study[J]. Anesth Analg, 2010,111(5):1133-1137. pmid: 20736432

相关文章 15

[1]	许素环,王蓓蓓,庞秋颖,钟丽君,丁炎明,黄燕波,车新艳. 等体温膀胱冲洗对经尿道前列腺电切术患者干预效果的meta分析[J]. 北京大学学报（医学版）, 2023, 55(4): 676-683.
[2]	李辉,高阳旭,王书磊,姚红新. 恶性肿瘤患儿完全植入式静脉输液港手术并发症[J]. 北京大学学报（医学版）, 2022, 54(6): 1167-1171.
[3]	白鹏,怀伟,夏天,杨钟玮,郭向阳,周方. 气管插管和喉罩在手术室与滑雪场雪道建立人工气道时间的比较[J]. 北京大学学报（医学版）, 2022, 54(1): 166-169.
[4]	李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报（医学版）, 2022, 54(1): 177-181.
[5]	董文敏,王明瑞,胡浩,王起,许克新,徐涛. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报（医学版）, 2020, 52(4): 637-641.
[6]	高健,胡立宝,陈尘,郅新,徐涛. 经皮肾镜去石术后出血的介入治疗[J]. 北京大学学报（医学版）, 2020, 52(4): 667-671.
[7]	马凯,曲星珂,许清泉,熊六林,叶雄俊,安立哲,陈伟男,黄晓波. 肾移植术后移植肾输尿管膀胱吻合口狭窄的腔内治疗:13例报道[J]. 北京大学学报（医学版）, 2019, 51(6): 1155-1158.
[8]	洪洪,钱宇婷,付磊,王武,李成辉,尹毅青. 困难气道中运用CT 三维重建技术指导硬质纤维气管镜行气管插管[J]. 北京大学学报（医学版）, 2019, 51(5): 870-874.
[9]	齐伟,李健男,赵静仁,邢海霞,潘洁. 角形切口设计和愈合方式与下颌阻生智齿拔除术后并发症[J]. 北京大学学报（医学版）, 2019, 51(5): 949-953.
[10]	梁晨,张维宇,胡浩,王起,方志伟,许克新. 膀胱扩大术两种不同术式的疗效及并发症比较[J]. 北京大学学报（医学版）, 2019, 51(2): 293-297.
[11]	徐稼轩,王宏志,董军,陈小杰,杨勇,陈仁雄,王国栋. 食管癌术后急性肺损伤/急性呼吸窘迫综合征的危险因素分析[J]. 北京大学学报（医学版）, 2018, 50(6): 1057-1062.
[12]	李旭, 李奉龙, 鲁谊, 朱以明, 郭斯翊, 李屹钧, 姜春岩. 锁定钢板治疗非骨质疏松性复杂肱骨近端骨折的中期临床及影像学随访研究[J]. 北京大学学报(医学版), 2017, 49(5): 855-860.
[13]	黄珺君，张红，章巍，王玺，龚玉红，王广发. 支气管镜下介入治疗早期并发症的独立危险因素[J]. 北京大学学报(医学版), 2016, 48(6): 1006-1011.
[14]	葛娜，关明，李茜，李率，王恩博. 可弯曲喉罩在颌面外科日间手术的应用[J]. 北京大学学报(医学版), 2015, 47(6): 1010-1014.
[15]	刘坤，徐宗源，孟峻嵩，傅广波，顾硕，顾民. 术前营养风险对根治性全膀胱切除术后并发症发生率的影响[J]. 北京大学学报(医学版), 2015, 47(5): 800-803.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

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