电子喉镜下杓状软骨复位术治疗杓状软骨脱位的临床疗效分析

Clinical analysis ofarytenoid cartilage reposition under electronic laryngoscope for artenoid cartilage dislocation

目的探讨麻醉插管后杓状软骨脱位患者的临床特征及表面麻醉电子喉镜下治疗杓状软骨脱位的临床疗效。方法2015年10月至2019年7月27例因麻醉插管后出现杓状软骨脱位患者27例,患者在表面麻醉电子喉镜直视下用"L"型异物钳根据脱位方向进行复位,首次复位无效或疗效不佳者再进行第2次复位。比较复位前、复位后1周及1月的频闪喉镜、听觉感知(GRABS)评估、声学值分析及嗓音障碍指数10(VHI-10)。结果复位术后,21例声带运动恢复正常,6例声带固定。复位前声音嘶哑分级G2为8例,G319例;复位后1周,G0为9例,G1为16例,G2为2例;复位后1月,G0为13例,G2为12例。复位后1周VHI-10总分及生理、情感、功能3个维度低于复位前;与复位后1周比较,复位后1月,VHI-10总分及生理、功能2个维度降低,基频(F0)、基频微扰(Jitter)、谐噪比(HNR),最长发音时间MPT均升高,Shimmer下降,差异均有统计学意义(P<0.05)。结论表面麻醉电子喉镜下的杓状软骨复位是治疗杓状软骨脱位的一种有效的治疗方法。患者的声学值和GRABS分级均有好转,嗓音相关生活质量得到提高。

Objective s To investigate the clinical characteristics of patients with arytenoid cartilage dislocation after general anesthesia intubation,and the clinical effect of arytenoid cartilage reposition under surface anesthesia through electronic laryngoscope.Methods From October 2015 to July 2019,27 cases with arytenoid cartilage dislocation after general anesthesia intubation were treated use"L"foreign body forceps to reposition according to the dislocation direction under the direct vision of surface anesthesia electronic laryngoscope.If the first reduction is invalid or the curative effect is not good,the second reduction should be performed.Stroboscope,voice handicap index(VHI-10),GRABS assessments,and acoustic analysis were compared before and after 1 week and 1 month of operation.Results After reduction,the movement of vocal cords returned to normal in 21 cases and fixed in 6 cases.Before reduction,hoarseness was classified as G2 in 8 cases and G3 in 19 cases before operation.After 1 week of reduction,there were 9 patients with G0,16 with G1 and 2 with G2.After 1 month of reduction,there were 13 with G0 and 12 with G2.After 1 week of reduction,the total score of VHI-10 as well as physiology(P),function(F)and emotion(E)dimensions in VHI-10 were lower than those before reduction were.The total score of VHI-10 as well as P and F dimensions in VHI-10 were decreased after 1 month of reduction when compared to that after 1 week of reduction.The acoustic analysis such as fundamental frequency(F0),Jitter,harmonic to noise ratio(HNR)and maximum phonation time(MPT)were increased while Shimmer was reduced(P<0.05).Conclusion The arytenoid cartilage reposition under surface anesthesia through electronic laryngoscope was an effective method for the treatment of arytenoid dislocation after general anesthesia intubation.The acoustic analysis and hoarseness classification are improved.Voice related quality of life is also improved.