严重气管软化症10例临床特点及文献复习.pdfVIP

国际呼吸杂志 2014 年 2 月第 34 卷第 4 期 Int J Respir.February 2014. Vo l. 34. No , 4 • 257 • ·论著· 严重气管软化症 10 例临床特点及文献复习 骆月琴王柏磊杨文龙 E摘要】 目的 回顾性分析 10 例 lCU 中经机械通气等治疗措施干预的严重气管软化症 (tracheomalacia. TM)患者的临床资料，以提高对该病的识别。方法 国顾性分析我院 lCU 收治的 10 例 严重 TM 患者的临床表现、胸部 CT 影像、纤维支气管镜检查资料及治疗转归。结果 10 例 TM 患者男 女比例相等。主要症状为呼气困难突发或加重.可伴咳嗽、咳痰困难，严重者表现为发作性窒息。体征 主要为气管昕诊区闻及吸气相或双相喘鸣音。胸部 CT 示呼气相气管狭窄。全组患者气囊漏气试验阳 性，纤维支气管镜下见用力呼气时气管壁向管腔内突出致气管狭窄或陷闭。结论 TM 的临床表现元特 异性，易误诊为 COPD 和支气管哮喘。胸部 CT 及气囊漏气试验可作为 TM 的早期筛查方法，纤维支气 管镜检查是诊断 TM 的金标准。 E关键词】 气管软化症;诊断;胸部 CT 影像;气囊漏气试验;纤维支气管镜检查 Clinical characteristiωof ten ca剑~ of severe tracheal malacia and Iiterature review Luo Yueqin. Wang Bol凹 .Yang Wenlong. Deρartment of Critical Care Medicine. Beihai Peoples Hospital •Beihai 536000. China [Abstract] Objective To improve the recognition of tracheomalacia (TM) by analyzing the clinical data of ten patients with serious TM who received mechanical ventilation in intensive care unit. Methods The clinical manifestations.chest CT images. fiberoptic bronchoscopy features and treatment outcome of ten patients with serious TM in intensive care unit were researched retrospectively. Results The number of male and female patients was equivalent. The main symptoms were onset or aggravation of expiratory dyspn他sometimes accompan咛 by cough and difficult expectoration. 时rious cases had paroxysmal asphyxia. The main physical sign of TM was hearing inspiratory phases or two phase wheezing on tracheal auscultatory area. Expiratory chest CT scan showed stenosis of trachea. The cuff-leak test in all patients was positive. Fiberoptic bronchoscopy demonstrated stenosis or complete collapse of the trachea during forced exhalation. Conclusions The clinical manifestations of TM are non-specific. which is easily misdiagnos