喉阻塞-2013重点.ppt

stridor Stridor is an 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 nasopharynx, 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 obstruction 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 inhaling 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 * 阻塞若位于胸外（如声带麻痹、炎症等），吸气时由于气道内压明显小于大气压，故可使气道狭窄加重；用力呼气时则因气道内压力大于大气压而可使阻塞减轻，故此类患者表现出明显的吸气性呼吸困难。 * 阻塞如位于中央气道的胸内部分，是由于吸气时气道内压大于胸内压，故可使阻塞减轻，用力呼气时则可因胸内压大于气道内压而加重阻塞，病人表现为呼气性呼吸困难。 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 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. Acute laryngitis and Epiglottitis Barking Cough Hoarse Voice Inspiratory Stridor Varying Degrees of Respiratory