喉阻塞-2013

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 laryngitisandEpiglottitis,Barking CoughHoarse VoiceInspiratory StridorVarying Degrees of Respiratory DistressAges 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:High feverSore throatDyspneaRapidly progressive respiratory obstruction,Clinical Course:Quick onset of fever, dyspneaOften sits leaning forward, drooling Inspiratory stridorRefuses to eatWithin hours may progress to respiratory obstructionCan occur at any age,Physical Findings:Left picture: nearly completely blocked airwayRight 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 dyspneainspiratory stridorThree/four depression signshoarse voiceOxygen 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,HistorySymptoms & 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 calmdyspnea 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. Stridor is loud. The patient is dysphoric because of hypoxemia. His sleep and eating are affected by lacking of oxygen.,degree IV : 呼吸极度困难.A extreme dyspnea.RestlessnessCyanosis (发绀)Hypotension,3 types of dyspnea,Inspiratory dyspnea Expiratory dyspneaMixed dyspnea,inspiratory dyspnea-胸外中央性气道阻塞,Expiratory,Inspiratory,expiratory dyspnea-胸内中央性气道阻塞,Expiratory,Inspiratory,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 obstructionwhile expiratory stridor implies bronchial obstructionBiphasic 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 obstructionAntibiotics + corticosteroid二度: 对症和全身治疗的同时积极病因治疗inhaling oxygenantibiotics+ corticosteroidpreparing 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 oxygenantibiotics+ cort