成人急性喉梗阻的临床急救与病因分析

Clinical first aid of acute laryngeal obstruction in adults and etiological analysis

目的总结并分析成人急性喉梗阻的临床急救特征及病因分类,以指导临床进行有针对性的治疗。方法收集2015年1月至2021年12月以憋气、吸气性呼吸困难为主要症状就诊于该院的急性喉梗阻患者的临床资料,行紧急气管切开术救治,分析其病因分布及特点。结果共收集94例各类病因引起的急性喉梗阻并行紧急气管切开术患者,男73例,女21例,年龄(65.44±12.23)岁。病因占比从高到低依次为肿瘤60例(63.83%)、双侧声带麻痹12例(12.77%)、炎症11例(11.70%)、外伤5例(5.32%)、喉水肿2例(2.13%)、巨大异物2例(2.13%)、气管切开术后脱管2例(2.13%)。不同病因患者年龄比较差异有统计学意义(F=4.463,P=0.001),且肿瘤、炎症及双侧声带麻痹患者的年龄[(67.21±10.45)岁]大于其他患者[(52.00±16.42)岁],差异有统计学意义(t=2.993,P=0.012)。不同严重程度急性喉梗阻患者男性均多于女性,但性别构成差异无统计学意义(P=0.469)。紧急气管切开术患者并发切口出血6例,皮下气肿5例,右侧气胸合并对侧肺不张1例,均对症治疗后好转。结论成人急性喉梗阻病情危急,常见的病因有肿瘤、双侧声带麻痹和炎症,紧急气管切开术风险及并发症发生风险相对较高。

Objective To summarize and analyze the clinical first aid characteristics and etiology classification of adult acute laryngeal obstruction so as to guide the targeted treatment in clinic.Methods The clinical data of the patients with the main symptoms such as suffocation and inspiratory dyspnea visiting in this hospital from January 2015 to December 2021 were collected.They conducted emergency tracheotomy for first aid,and their etiological distribution and characteristics were analyzed.Results A total of 94 patients with acute laryngeal obstruction and emergency tracheotomy caused by various causes were collected,73 males and 21 females,aged(65.44±12.23)years old.The proportions of disease causes from high to low were in turn 60 cases of tumor(63.83%),12 cases of bilateral vocal cord paralysis(12.77%),11 cases of inflammation(11.70%),5 cases of trauma(5.32%),2 cases of laryngeal edema(2.13%),2 cases of giant foreign matter(2.13%)and 2 cases of tube taking off after tracheotomy(2.13%).The age had the statistical difference among different etiologies(F=4.463,P=0.001).The age in the patients with tumor,infection and bilateral vocal cord paralysis was greater than that of the other groups with statistical difference[(67.21±10.45)years old vs.(52.00±16.42)years old,t=2.993,P=0.012].The male patients with different severities of acute laryngeal obstruction were more than female patients,but the difference in the sex composition was not statistically significant(P=0.469).Among the patients with emergency tracheotomy,there were 6 cases of complicating incision bleeding and 5 cases of subcutaneous emphysema;1 case of right pneumothorax complicating apposite side atelectasis,and all were improved by symptomatic treatment.Conclusion Acute laryngeal obstruction in adults is critical.The common causes include tumor,bilateral vocal cord paralysis and inflammation.The risk of emergency tracheotomy and complications occurrence risk are relatively high.