喉阻塞2013课件

Laryngeal obstruction 喉阻塞 肖自安 教授 A dangerous emergency Etiology 炎症inflammatory 外伤Laryngeal trauma 异物laryngeal foreign bodies 水肿laryngeal edema 肿瘤Laryngeal tumors 畸形laryngeal deformity 喉狭窄或声带瘫痪laryngeal stenosis and bi- recurrent laryngeal nerve paralysis Upper airway obstruction An upper airway obstruction is a blockage of the upper airway, which can be in the trachea, voice box (laryngeal), or throat (pharyngeal) areas. Acute laryngitis and Epiglottitis Barking Cough Hoarse Voice Inspiratory Stridor Varying Degrees of Respiratory Distress Ages infancy 1-3 (peak 2 years) 小儿易发生喉阻塞的原因 小儿声门狭小 小儿喉粘膜下组织疏松 小儿喉软骨支架柔软 小儿会厌卷曲后倾 A dramatic, potentially life-threatening form of upper airway obstruction characterized by: qHigh fever qSore throat qDyspnea qRapidly progressive respiratory obstruction Clinical Course: qQuick onset of fever, dyspnea qOften sits leaning forward, drooling qInspiratory stridor qRefuses to eat qWithin hours may progress to respiratory obstruction Can occur at any age Physical Findings: Left picture: nearly completely blocked airway Right picture: airway opened after intubation Lateral soft tissue neck x- ray: “thumbprint” sign Definition 因喉部或临近组织病 变,使喉部通道(特别 是声门)发生狭窄或阻 塞,引起呼吸困难. Laryngeal obstruction is a symptom of dyspnea or shortness of respiration caused by narrowing or blockage of the laryngeal cavity (especially the glottis). Clinical presentations 吸气性呼吸困难 吸气性喉鸣 吸气性软组织凹陷 (三凹征,四凹征) 声音嘶哑 缺氧症状 inspiratory dyspnea inspiratory stridor Three/four depression signs hoarse voice Oxygen deficiency symptoms Three/four depression signs: depression in suprasternal fossa, supraclavicular fossa, intercostal space, epigastric zone 喉阻塞缺氧病理生理改变 缺 氧 CO2储留 毛细血管渗透性 脑心肺肾 体力消耗 Diagnosis History Symptoms & signs The degree of dyspnea degree I : 安静时无呼吸困难. no dyspnea when in calm, a slight inspiratory stridor and dyspnea when moving or crying degree II :安静时也有轻度呼吸困难,不影 响睡眠和进食,脉搏正常. a slight inspiratory stridor and dyspnea when in calm dyspnea become more serious when moving or crying, no affect sleep and eating degree III : 吸气期呼吸困难明显,喉喘鸣,烦躁不 安,影响睡眠和进食,脉搏加快. The inspiratory dyspnea is obvious. The inspiratory dyspnea is obvious. Stridor is loud. Stridor is loud. The patient is dysphoric because of The patient is dysphoric because of hypoxemia. His sleep and eating are hypoxemia. His sleep and eating are affected by lacking of oxygen.affected by lacking of oxygen. degree IV : 呼吸极度困难. A extreme dyspnea.A extreme dyspnea. RestlessnessRestlessness Cyanosis (Cyanosis (发绀发绀) ) HypotensionHypotension 3 types of dyspnea Inspiratory dyspnea Expiratory dyspnea Mixed dyspnea inspiratory dyspnea-胸外中央性气道阻塞 ExpiratoryInspiratory expiratory dyspnea-胸内中央性气道阻塞 ExpiratoryInspiratory 三种阻塞性呼吸困难的鉴别要点 吸 气 性 呼 气 性 混 合 性 病 因 喉的阻塞性 小支气管阻塞 气管中下段或上, 疾病(炎症, 性疾病(支气管 下呼吸道同时有 肿瘤,异物） 哮喘,肺气肿） 阻塞性疾病 呼吸深度 吸气变强,延 呼气变强,延长 呼，吸均变强 与频率 长,频率不变 吸气亦强 三凹症 明显 无 可有 呼吸伴发声 吸气性喉鸣 呼气性哮喘 无 检 查 咽喉有阻塞性 肺充气过多 可闻及哮鸣声 病变,肺充气 stridor Stridor is an abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway at the level of the supraglottis, glottis, subglottis, and/or trachea. * it should be differentiated from stertor(鼾声), which is a lower-pitched, snoring-type sound generated at the level of the nasopharynx, oropharynx, and, occasionally, supraglottis. * Stridor is a symptom, not a diagnosis or disease, and the underlying cause must be determined. Stridor may be inspiratory, expiratory, or biphasic depending on its timing in the respiratory cycle. Inspiratory stridor suggests a laryngeal obstruction while expiratory stridor implies bronchial obstruction Biphasic stridor suggests a tracheal (subglottic or glottic anomaly.) Treatment 原则：分秒必争，重点解除喉阻塞。 1、吸氧 2、激素，抗生素 3、气管切开术,气管插管 4、明确病因和病因处理 Treatment 一度: 积极的病因治疗 relieving laryngeal obstructionrelieving laryngeal obstruction Antibiotics + corticosteroidAntibiotics + corticosteroid 二度: 对症和全身治疗的同时积极病因治疗 inhaling oxygeninhaling oxygen antibiotics+ corticosteroidantibiotics+ corticosteroid preparing for tracheostomypreparing for tracheostomy 三度: 严密观察,对症和积极病因治疗无好转时,及 时气管切开 inhaling oxygeninhaling oxygen antibiotics+ corticosteroidantibiotics+ corticosteroid trac