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題名 | 嬰幼兒之雙側聲帶麻痺=Bilateral Vocal Cord Paralysis in Infants and Children |
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作者 | 翁韶嶽; 李國森; 楊政謙; 張克昌; Wong, Shao-yueh; Lee, Kuo-sheng; Yang, Cheng-chien; Chang, Ke-chang; |
期刊 | 中華民國耳鼻喉科醫學會雜誌 |
出版日期 | 19980600 |
卷期 | 33:3 1998.06[民87.06] |
頁次 | 頁9-15 |
分類號 | 417.688 |
語文 | chi |
關鍵詞 | 雙側聲帶麻痺; 嬰幼兒; 氣管切開術; Bilateral vocal cord paralysis; Infants and children; Tracheotomy; |
中文摘要 | 背景:雙側聲帶麻痺是嬰幼兒呼吸道異常的常見原因之一。特性為時常合併其他 先天性異常,嚴重的呼吸道阻塞、常需氣管切開及部份病患有自然恢復的現象。 方法:本科自 1994 年 4 月至 1997 年 7 月共經歷 19 例雙側聲帶麻痺的嬰幼兒。診斷乃 由纖維內視鏡確定。依性別、症狀發生年齡、臨床表現、合併之先天異常、懷孕史、追蹤、 治療及預後做一分析討論。 結果:19 例雙側聲帶麻痺的嬰幼兒中,男性 8 例,女性 11 例,63.2% 為一出生即出現症 狀。 症狀方面,可見發紺( 89.5% )、喘鳴( 78.9% )、無法順利拔管( 73.7% )、胸 部凹陷( 68.4% )等。42.1% 有異常懷孕史或生產史。 分析其病因,不明原因佔 47.4%, 神經確定時間離症狀出現時間平均約 26 天。42.1% 在症狀出現後二週,78.9% 在一個月內 被診斷出來。共 15 例( 78.9% )接受氣管切開。平均追蹤時間自診斷確定算起約 9.7 個 月,有 2 例已恢復聲帶運動。 結論:嬰幼兒雙側聲帶麻痺須依賴臨床醫師的高度懷疑。我們主張應及早施行氣管切開。由 於常合併其他先天異常,仔細評估中樞神經系統、心血管系統及呼吸道是必要的。病患應持 續追蹤,以觀察聲帶運動是否恢復。 |
英文摘要 | Background: Bilateral vocal cord paralysis is not an uncommon cause of airway anomalies in infants and children. It's characterized by high frequency of associated congenital anomalies, severe airway obstruction, necessity of tracheotomy, and possibility of spontaneous recovery. Mothods: Nineteen infants and children were diagnosed as having bilateral vocal cord paralysis from April, 1994 to July, 1997. Diagnosis was made with videofiberoptic endoscopy. A retrospective analysis including sex, age at presentation, clinical manifestations, associated congenital anomalies, pregnancy or birth problems, treatment, follow-up and prognosis is discussed. Results: There were 8 males and 11 females. Sixty-three percentage of them were symptomatic at birty. Clinical manifestations included cyanosis (89.5%), stridor (78.9%), failure of extubation (73.7%), chest retraction (68.4%) etc. Pregnancy or birth problems occurred in 42.1% of cases. The etiologies were idiopathic (47.4%), neurogenic (26.3%), cardiogenic (15.8%), birth injury (5.3%) and iatrogenic (5.3%). The average time of delay in diagnosis was 26 days. Fourty-two percentage of them were diagnosed within two weeks after symptoms developed. Tracheotomy was performed in 78.9% of cases. The average time of follow-up was 9.7 months. Two cases were found to have recovery of vocal cord mobility. Conclusions: High index of suspicion was the mainstay of early detection of bilateral vocal cord paralysis. Videofiberoptic endoscopy is the best method of diagnosis. Tracheotomy is necessary in most cases. Due to high frequency of associated anomalies, it's necessary to evaluate the CNS, the cardiovascular system and the upper aerodigestive tract. The patients should be serially followed up for vocal cord movement due to possibility of spontaneously resolution. |
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