摘要
目的探讨全麻气管插管手术导致声带麻痹的原因、治疗方法及预后。方法对10例全麻气管插管分别行胸、腹部手术后立即出现声嘶、发声困难、误吸等症状的患者行纤维喉镜及喉肌电图检查，排除了环杓关节脱位等其他病变，均确诊为声带麻痹（9例单侧，1例双侧），对其中6例行患侧环甲关节部注射新斯的明0．5～1mg、维生素B1 100mg，隔日1次，共5次；2例肌肉注射上述药物1次／天，共10天；另2名未经特殊治疗。结果10例患者声带麻痹的原因主要可能为喉返神经或迷走神经受损或中毒性神经炎，8例（5例环甲关节注射者，2例肌肉注射者，1例未治者）分别于术后34～73（平均50．25）天患侧声带恢复运动功能，2例（1例未治者，1例环甲关节注射者）分别于术后40、45天未恢复而失访。结论气管插管导致声带固定，较为常见的原因为环杓关节脱位，喉神经麻痹亦非罕见，应注意鉴别，喉肌电图检查有助于明确诊断。气管插管导致的喉神经麻痹如果治疗及时，预后较好，一般术后3个月左右多可恢复正常声带运动功能。
Objective To investigate the etiology, treatment and prognosis of vocal cord paralysis caused by endotrachea intubation in the operations of general anaesthesia. Methods 10 patients who immediately presented hoarseness, dysphonia and aspiration after the operations for breast and abdominal regions were examined by fibrolaryngoscopy and/or laryngeal electromyography. The dislocation of the cricoarytenoid articulation was excluded and the vocal cord paralysis was diagnosed （unilateral paralysis in 9 patients and bilateral in one）. Neostigmine 0.5 - 1 mg plus vitamin B1 100 mg were injected in the sites about the cricothyroid joints of the paralysis side in 6 patients one time every other day for 5 times in total. 2 patients were injected with the medicines described above in muscles one time every day for 10 times in all. The other 2 patients were not treated. Results 8 of 10 patients recovered the normal function of the vocal cord movement in 34-73（average 50.25）days following operation. The other two patients who failed to recover on 40th and 45th day separately were not followed up any more. Cocnclusion It is common that the vocal cord paralysis is caused by endotrachea intubation, although the dislocation of cricoarytenoid articulation is frequent. It＇ s important to distinguish those conditions. The laryngeal electromyography conduces to correct diagnosis. If the vocal cord paralysis caused by endotrachea intubation is timely treated, the prognosis is expected to be good. In general the normal vocal cord movement may recover about 3 months after operation.
出处
《听力学及言语疾病杂志》
CAS
CSCD
2007年第5期367-369,共3页
Journal of Audiology and Speech Pathology
关键词
气管插管
声带麻痹
喉肌电图
新斯的明
Endotrachea intubation
Vocal cord paralysis
Laryngeal electromyography
Neostigmin
