气管插管后声带运动障碍的原因及其相关因素

Causes of vocal cord dyscinesia and its original factors after endotracheal intubation

目的:分析气管插管全身麻醉术后声带运动障碍的原因及其相关因素。方法:通过电子喉镜、频闪喉镜检查、CT三维重建、杓状软骨拨动复位术治疗等判定135例全身麻醉术后声带运动障碍患者的原因。从患者插管条件与插管操作者技术水平、患者体态状况、年龄、带管时间、手术类别以及麻醉过程管理等方面分析声带运动障碍发生原因的相关因素。结果:135例患者中,128例(94.81%)声带运动障碍原因为杓状软骨脱位,7例(5.19%)为声带麻痹。声带运动障碍与插管困难有关者占76.30%;与麻醉过程起伏有关者达65.19%;在插管顺利的患者中,体态及颈部相对瘦长者占90.62%;不同年龄段所占比率差异无统计学意义;带管时间>12h的患者仅占全部声带运动障碍者的9.63%;心胸手术后出现声带运动障碍的发病率近0.50%,占全部声带运动障碍者的59.26%。结论:杓状软骨脱位及声带麻痹是全身麻醉术后声带运动障碍的主要原因;重视患者插管条件和麻醉过程管理,提高插管技术水平有可能降低声带运动障碍原因的发生。

Objective：To research the causes of postintubation vocal cord dyskinesia and its contributing factors.Method：The causes of vocal cord dyskinesia were confirmed by laryngoscope,three-dimensional spiral CT,stroboscope,and the analysis of therapy.The factors relevant to the causes of vocal cord dyskinesia were analysed based on the following elements：①the anatomic or pathological condition of patients or the technical skills of anesthetists.②emaciated or obese body and neck.③the age of patients.④the duration of endotracheal tube retention.⑤the types of operations.⑥anesthesia procedure.Result：Among 135 patients,128 cases（94.81%） manifested arytenoid dislocation,7 cases（5.19%） vocal cord paralysis.The study showed that the vocal cord dyskinesia associated with anatomic or pathological condition of patients and technical skills of anesthetists（with intubation difficulty）accounted for 76.30%.The patients with relative emaciated body or neck accounted for 90.62% in cases without intubation difficulty.Age had no significant analytical relationship with vocal cord dyskinesia.Prolonged intubation（endotracheal tube retention over 12 hours） was accounted for only 17.64%.The incidence of vocal cord dyskinesia was nearly 0.5% in patients underwent cardio-throacic surgery,accounting for 59.26% of all the patients.Conclusion：There are two major causes of vocal cord dyskinesia： arytenoid dislocation and vocal cord paralysis,and the rate of vocal cord dyskinesia could be reduced by the improvement of technical skill of anesthetists and/or sufficient attention to the intubation condition of patients.