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1、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 obstructionAn upper airway obstru
2、ction 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 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
3、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 fever Sore throat Dyspnea Rapidly progressive respiratory obstruction,Clinical Course: Quick onset of fever, dyspnea Often sits leaning forward, drooling Inspiratory stridor Refuse
4、s to eat Within hours may progress to respiratory obstructionCan 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.,Laryng
5、eal 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 Oxyg
6、en 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 insp
7、iratory 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
8、. 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. Restlessness Cyanosis (发绀) Hypotension,3 types of dyspnea,Inspiratory dyspnea Expiratory dyspnea Mixed dyspnea,inspiratory dyspnea-胸外中央性气道阻
9、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
10、 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 nasophar
11、ynx, 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 obstructio
12、n 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 obstruction Antibiotics + corticosteroid 二度: 对症和全身治疗的同时积极病因治疗 inhali
13、ng oxygen antibiotics+ corticosteroid preparing 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 oxygen antibiotics+ corticosteroid tracheotomy 四度: 立即气管切开手术 emergency tracheotomy,治疗气管切开术 tracheotomy,手术类型： 常规气管切开术 紧急气管切开术 环甲膜切开术,Key points,Definition Clinical presentations The degrees of dyspnea The principle of treatment,
