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  • Title: [Clinical outcomes of vocal fold immobility after tracheal intubation].
    Author: Geng ZY, Gao WH, Wang DX.
    Journal: Beijing Da Xue Xue Bao Yi Xue Ban; 2020 Sep 03; 53(2):337-340. PubMed ID: 33879908.
    Abstract:
    OBJECTIVE: To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia. METHODS: We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed. RESULTS: A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge. CONCLUSION: Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately. 目的: 分析全身麻醉气管插管患者术后声带运动不良的发生率。 方法: 回顾北京大学第一医院2014年1月至2018年12月所有全身麻醉气管插管手术患者的围术期病历资料，分析术后声音嘶哑和声带固定的发生率与临床结局。 结果: 5年内共纳入分析85 998例全身麻醉气管插管患者，其中222例(0.26%)发生术后声音嘶哑，29例患者为持续声音嘶哑，经耳鼻喉科医生明确诊断，其中7例为咽喉炎，22例(0.026%)为术后声带固定，左侧声带固定较多见为17例(77%)，右侧声带固定5例(23%)。22例声带固定患者中，9例患者确诊为杓状软骨脱位，其中7例为左侧声带固定，2例为右侧声带固定；7例为可视喉镜引导气管插管，1例为困难气道，在光棒引导下插管，1例为喉罩置入。1例可疑为麻醉前插胃管导致，1例合并左喉返神经功能异常，3例患者给予局部麻醉下闭合复位，1例自行复位缓解，症状持续时间16 d(5~31 d)。其余13例声带固定患者中，2例患者为声带麻痹，11例患者为颈部、甲状腺和心胸手术，未能进一步检查明确病因诊断。所有患者均给予激素雾化等对症治疗，离院时5例症状明显好转或接近正常，1例症状有缓解，16例症状未缓解。 结论: 全身麻醉气管插管患者术后出现持续声音嘶哑和声带运动不良者应尽可能及时诊断治疗。
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