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頁籤選單縮合
題名 | Outcome of Vocal Cord Paralysis in Infants=嬰兒聲帶麻痺之預後 |
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作者 | 李俊昌; 蘇百弘; 林鴻志; 蔡宜靜; 林嘉德; 林宗文; Lee, Chun-chang; Su, Bai-horng; Lin, Hung-chih; Tsai, Yi-ching; Lin, Chia-der; Lin, Tsung-wen; |
期刊 | 臺灣兒科醫學會雜誌 |
出版日期 | 20040900、20041000 |
卷期 | 45:5 民93.09-10 |
頁次 | 頁278-281 |
分類號 | 417.688 |
語文 | eng |
關鍵詞 | 嬰兒; 聲帶麻痺; Vocal cord Paralysis; Stridor; Infant; Direct flexible laryngoscopy; |
中文摘要 | 喘鳴是一歲以下的嬰幼兒呼吸窘迫常見的主訴,而喉頭軟化症是最常見的原因。雖然嬰幼兒罹患聲帶麻痺相當罕見,但它卻是引起喘鳴第二常見的原因。從1997年1月到2003年12月,有13位小於一歲以下的嬰幼兒罹患聲帶麻痺在本院接受治療。其中有7位原因不明,2位可歸因於之前的手術傷及神經,另外2位是因中樞神經病變引起,最後有2位是肇因於難産。在原因不明群中,有1位病患的右側聲帶麻痺有恢復,但左側沒有恢復,其餘的6位都有自行恢復,包括醫源性和難産的,但是中樞神經病變的患者都沒有恢復。長期的預後雖因造成原因而有所不同,但大部份的自行恢復都發生在6個月之內。以此經驗來看,我們建議對於以喘鳴爲表現的嬰幼兒都應安排軟式織維鏡呼吸道檢查,才能獲得正確的診斷。對於聲帶麻痺的嬰幼兒,除了雙側聲帶麻痺合併嚴重的呼吸窘迫及中樞神經病變可能需要暫時性的氣管造口術之外,可以觀察6個月再決定是否採取進一步侵襲性的手術治療。 |
英文摘要 | Although laryngomalacia is the leading cause of stridor in infancy, vocal cord paralysis, despite its low incidence, is still the second most common cause. However, the etiology of infant vocal cord paralysis is different from that of adults, and the management protocol is controversial. Therefore, we conducted this study to better characterize the cause and outcome of vocal cord paralysis in infants. From January 1997 to December 2003, we treated thirteen infants younger than one year for vocal cord paralysis. Seven infants were idiopathic (idiopathic group), two might be caused by prior surgery (iatrogenic group), two might be caused by central neuropathy (neurological group), and two were born after difficult delivery (obstetrical group). In the idiopathic group, six infants spontaneously recovered and one infant had right-side recovery, but the left side was still paralytic. All infants in the iatrogenic and obstetrical groups spontaneously recovered. However, no infant in the neurological group recovered. Spontaneous recovery occurred in 76.9% of affected infants. More than half (70%) of these spontaneous recoveries occurred within 6 months. In our experience, direct flexible laryngoscopy is mandatory for all infants younger than one year of age presenting with stridor. Except for extreme infants (e. g. bilateral vocal cord paralysis with severe respiratory distress and central neuropathy) who require a temporary tracheotomy to relieve the airway obstruction, we recommend waiting for at least 6 months before proceeding to invasive surgical interventions. |
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