妊娠期咽喉反流引起喉梗阻的诊治探讨(附1例报告)

Diagnosis and treatment of laryngeal obstruction caused by laryngeal reflux during pregnancy:a case report

目的通过回顾性分析2019年11月收治的1例妊娠期咽喉反流引起喉梗阻患者的资料以探讨妊娠期咽喉反流引起喉梗阻的诊治。方法患者女,29岁,孕28周。因"声嘶1个月、吞咽伴呼吸困难半个月"入院,患者入院时喉梗阻Ⅲ度,电子喉镜检查提示会厌无水肿,环后区黏膜水肿明显,声带黏膜充血、水肿,声门裂狭窄,紧急行气管切开,并行喉部活检术。患者填写入院时、治疗1个月后、产后1个月反流症状指数评分量表(RSI),医师根据电子喉镜填写入院时、治疗1个月后、产后1个月反流体征评分量表(RFS)。结果患者气管切开后呼吸困难缓解,喉部病理活检提示炎性细胞浸润,间质充血,未见癌细胞。患者入院时、治疗1个月后、产后1个月RSI评分分别为15、13、7分;入院时、治疗1个月后、产后1个月RFS评分分别为17、17、9分。产后1个月成功拔管。结论反流是妊娠期常见反应,但妊娠期反流引起喉梗阻报道极少。抗酸药在妊娠期有一定的安全性,但疗效还有待进一步研究。反流症状严重出现喉梗阻Ⅲ、Ⅳ度时可考虑行气管切开,反流所致的症状和体征可在妊娠结束后逐渐消失。

Objective To investigate the diagnosis and treatment of laryngeal obstruction caused by laryngeal reflux,it was retrospectively analyzed for the data of a patient with laryngeal obstruction caused by laryngeal reflux during pregnancy admitted in November 2019.Methods The patient was female,29 years old,28 weeks gestation.The patient was admitted for“hoarseness for 1 month,swallowing with dyspnea for half a month”,who hadⅢdegree laryngeal obstruction at the time of admission.Electronic laryngoscopy showed epiglottis without edema,but obvious edema of the mucosa in the posterior ring zone,vocal cord mucosal hyperemia,edema,and glottic fissure stenosis.Emergency tracheotomy and laryngeal biopsy were performed.Patients filled in the Reflux Symptom Index(RSI)for admission,1 month after treatment,and 1 month after childbirth.Reflux symptom index(RSI)on admission,1 month after treatment,and 1 month after childbirth.Results The patient’s dyspnea was relieved after tracheotomy.A pathological biopsy of the larynx revealed inflammatory cell infiltration,interstitial congestion,and no cancer cells.The RSI of the patients at admission,1 month after treatment,and 1 month after delivery were 15,13,7.The RFS at admission,1 month after treatment and 1 month after childbirthm were 17,17,9 respectively.The catheter of the patient was extubated successfully 1 month after delivery.Conclusion Reflux is a common reaction during pregnancy,but there are few reports of laryngeal obstruction caused by reflux during pregnancy.Antacids have some safety during pregnancy,but the efficacy of the drugs needs to be further studied.Tracheotomy can be considered when the symptoms of reflux are severe in theⅢ、Ⅳdegree of laryngeal obstruction.The symptoms and signs caused by reflux can gradually disappear after the end of pregnancy.