严重气管软化症10例临床特点及文献复习

Clinical characteristics of ten cases of severe tracheal malacia and literature review

目的回顾性分析10例ICU中经机械通气等治疗措施干预的严重气管软化症（tracheomalacia，TM）患者的临床资料，以提高对该病的识别。方法回顾性分析我院ICU收治的10例严重TM患者的临床表现、胸部CT影像、纤维支气管镜检查资料及治疗转归。结果10例TM患者男女比例相等。主要症状为呼气困难突发或加重，可伴咳嗽、咳痰困难，严重者表现为发作性窒息。体征主要为气管听诊区闻及吸气相或双相喘鸣音。胸部CT示呼气相气管狭窄。全组患者气囊漏气试验阳性，纤维支气管镜下见用力呼气时气管壁向管腔内突出致气管狭窄或陷闭。结论TM的临床表现无特异性，易误诊为COPD和支气管哮喘。胸部CT及气囊漏气试验可作为TM的早期筛查方法，纤维支气管镜检查是诊断TM的金标准。

Objective To improve the recognition of tracheomalacia （TM） by analyzing the clinical data of ten patients with serious TM who received mechanical ventilation in intensive care unit. Methods The clinical manifestations,chest CT images, fiberoptic bronchoscopy features and treatment outcome of ten patients with serious TM in intensive care unit were researched retrospectively. Results The number of male and female patients was equivalent. The main symptoms were onset or aggravation of expiratory dyspnea, sometimes accompanied by cough and difficult expectoration, serious cases had paroxysmal asphyxia. The main physical sign of TM was hearing inspiratory phases or two phase wheezing on tracheal auscultatory area. Expiratory chest CT scan showed stenosis of trachea. The cuff-leak test in all patients was positive. Fiberoptic bronchoscopy demonstrated stenosis or complete collapse of the trachea during forced exhalation. Conclusions The clinical manifestations of TM are non-specific, which is easily misdiagnosed as chronic obstructive pulmonary disease and bronchial asthma. Chest CT and cuff-leak test can be used as early screening methods of TM. Fiberoptic bronchoscopy is the gold standard for the diagnosis of TM.