改善急性喉气管外伤管理中的结局

文献信息

中文摘要

目的与目标： 突出展示印度南部一家三级医院专职喉科单元所管理的急性喉气管外伤患者的临床表现、管理及功能结局。
方法： 对2014年1月1日至2023年8月31日期间急性喉气管外伤病例的医疗记录进行回顾性审查。收集的数据包括人口学资料、外伤机制、年龄和性别、临床表现、从受伤到干预的时间、检查、Schaefer-Fuhrman（SF）分级、管理（气道建立、手术技术及保守方法）和结局。并发症（通过分级并发症分类分为轻度、中度、重度）、功能性气道、嗓音和吞咽结局分别在随访结束时及一年随访结束时进行分析。
结果： 本研究期间共管理68例喉气管外伤患者（57例男性，11例女性）。除2例外，所有患者均在创伤后48小时内接受了确定性治疗。其中91.2%（n=62）在受伤后24小时内得到管理。我们遇到2例死亡，1例患者在紧急管理期间发生缺氧缺血性脑病（HIE）。主要受伤方式为机动车事故（41%，n=28）。SF III组和IV组分别见于33.8%（n=23）和29.4%（n=20）的患者。使用可吸收聚乳酸羟基乙酸（vicryl）缝线进行喉内黏膜修复以及骨折软骨段的复位和固定。在需要手术的54例患者中，仅16%（n=11）需要支架置入。气管切开患者中96%（n=48/50）成功拔管，90.7%（n=39/43）成功从辅助喂养康复至经口进食。在1年随访期间，分别有11%、3%和3%的患者出现嗓音、气道和吞咽结局不良。长期主要并发症见于6%（n=4），次要并发症见于15.4%（n=10）。
结论： 早期干预仍然是喉气管外伤成功管理的关键。这项单机构研究主要以经验丰富的团队进行早期确定性管理为特征；即使使用简单、易得、廉价的材料——如用于黏膜和软骨对合的可吸收缝线，以及改良气管导管作为支架——也能够取得良好的结局。

英文摘要

AIMS AND OBJECTIVES: To highlight the presentation, management, and functional outcomes of subjects with acute laryngotracheal trauma, managed by a dedicated laryngology unit in a tertiary care hospital in South India.
METHODS: A retrospective review of the medical records of acute laryngotracheal trauma cases from 1st January 2014 to 31st August 2023 was carried out. Data collected included demographics, mechanism of trauma, age, and sex, presentation, time of injury to intervention, investigations, Schaefer-Fuhrman (SF) grade, management (airway access, surgical techniques & conservative methods) and outcomes. Complications (via a graded complication classification grouped into mild, moderate , severe), functional airway, voice and swallowing outcomes were analysed separately as well as at the end of one year follow up.
RESULTS: Sixty-eight subjects (57 males and 11 females) with laryngotracheal trauma were managed during this study period. All but 2 subjects received definitive management within 48 hours of the trauma. 91.2% (n=62) of them were managed within 24 hours of the injury. We encountered 2 deaths and one subject developed Hypoxic Ischaemic encephalopathy (HIE) during emergent management. Main mode of injury was motor vehicular accident (41%, n=28). SF group III and IV was observed in 33.8% (n=23) and 29.4% (n=20) subjects. The endolaryngeal mucosal repair as well as reduction and stabilisation of fractured cartilage segments were done using absorbable polyglactin (vicryl). Of the 54 who required surgery only 16 % (n=11) required stenting. Successful decannulation was achieved in 96% of the tracheostomised subjects (n=48/50) and successful rehabilitation from assisted to oral feeding was possible in 90.7 % (n=39/43). Poor voice, airway and swallowing outcomes were seen in 11%, 3% and 3% of our subjects during 1 year follow up. Long -term major complications were seen in 6% (n=4) and minor ones in 15.4 % (n=10).
CONCLUSION: Early intervention remains pivotal for successful management of laryngotracheal trauma. This single institutional study, characterized primarily by early definitive management by an experienced team; was able to achieve favourable outcomes even with the use of simple, readily available, inexpensive materials like - absorbable sutures for mucosal and cartilage approximation, and modified endotracheal tube as stents.