喉阻塞

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 fever Sore throat Dyspnea Rapidly progressive respiratory obstruction
Acute laryngitis and Epiglottitis
• • • •
Barking Cough Hoarse Voice Inspiratory Stridor Varying Degrees of Respiratory Distress
Ages infancy [1-3] (peak 2 years)
• 吸气性软组织凹陷
(三凹征,四凹征)
• 声音嘶哑 • 缺氧症状
• Three/four depression
signs: depression in suprasternal fossa,
supraclavicular fossa,
intercostal space,
epigastric zone
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.)
inspiratory dyspnea--胸外中央性气道阻塞
Inspiratory
Expiratory
expiratory dyspnea--胸内中央性气道阻塞
Hale Waihona Puke InspiratoryExpiratory
stridor
• Stridor is an abnormal, high-pitched sound
• 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
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
• 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
Clinical Course:
Quick onset of fever, dyspnea Often sits leaning forward, drooling Inspiratory stridor Refuses to eat Within hours may progress to respiratory obstruction
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 – inhaling oxygen – antibiotics+ corticosteroid – preparing for tracheostomy
喉阻塞缺氧病理生理改变
缺 氧 CO2储留 体力消耗
毛细血管渗透性
脑心肺肾
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
“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).
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.
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
Laryngeal obstruction 喉阻塞
中南大学湘雅二医院耳鼻咽喉头颈外科 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 birecurrent laryngeal nerve paralysis
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
Clinical presentations
• 吸气性呼吸困难
• inspiratory dyspnea • inspiratory stridor • Three/four depression signs • hoarse voice • Oxygen deficiency symptoms
• 吸气性喉鸣
Can occur at any age
Physical Findings: Left picture: nearly completely blocked airway Right picture: airway opened after intubation
Lateral soft tissue neck xray:
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.