成人危重呼吸道阻塞的临床诊断和治疗

Diagnosis and treatment of serious adult airway obstruction

目的：探讨成人危重呼吸道阻塞的临床诊断及治疗方案。方法：1995年1月-2006年12月我科收治86例成人危重呼吸道阻塞,采用快速诊断和及时解除呼吸困难的临床处理方法,分析应用该方法的效果。结果：86例危重患者中,炎症性疾病34例,占39.5%;肿瘤性疾病32例,占37.2%;外伤性疾病9例,占10.5%。其他还有喉痉挛3例,喉狭窄6例,双侧声带麻痹2例,鼻咽癌放疗后大出血误吸窒息1例。喉和气管阻塞分别为60例和13例,占69.8%和15.1%。采用气管切开和气管插管分别为46例和4例,占53.5%和4.7%。只采用内科治疗缓解呼吸困难26例。86例患者均于2h内确诊并解除重度呼吸道阻塞。发生严重并发症者14例,发生率为16.3%;手术并发症6例,发生率为6.9%。死亡1例。结论：成人危重呼吸道阻塞的病因复杂,阻塞部位和性质多变,采取快速诊断、及时解除呼吸道阻塞的诊疗方案,是确保疗效的关键。

Objective：To investigate the diagnosis and treatment of serious adult airway obstruction. Method： Eighty six adult cases admitted to our hospital for serious airway obstruction from 1995 to 2006, were analyzed retrospectively. Result：Among the 86 cases, 34 cases（39.5%） had inflammatory diseases, 32 cases （37.2%） had neoplastic diseases and 9 cases（10.5%） had traumatic diseases. In addition,3 cases of laryngeal spasm, 6 cases of laryngeal stricture, 2 cases of bilateral laryngeal paralysis and 1 case of asphyxia with aspiration were also include in this study. The patients who had laryngeal or tracheal obstruction were 60 cases （69.8%） and 13 cases （15. 1% ）. In addition, 46 cases（53.5%） and 4 cases（4.7%） had tracheotomyorendotrachealintubation. Twenty six cases were only adopted medical treatment to relieve dyspnea. The final diagnosis of the 86 cases was made and the serious airway obstruction was was relieved within 2 hours. While 14 cases（16.3% ） had serious complications and 6 cases（6.9% ） had operative complications occurred . One cases（0.2%） died. Conclusion：The cau- ses of serious adult airway obstruction could be complicated, the site and character of obstruction would change constantly. Quick diagnosis, timely removal of the obstruction should be critical factors to improve curative effect.