흡입화상환자에서 후두기관 협착증의 발생 위험인자에 대한 고찰
Laryngotracheal Stenosis in Burned Patients with Inhalation Injury： Analysis of Risk Factors
1
조회
0
다운로드
1
인용
0
참고문헌
초록
Laryngotracheal stenosis (LTS) in burned patients with inhalation injury have features distinct from other stenosis after intubation or tracheotomy. However, the risk factors for LTS in burned patients with inhalation injury have not been thoroughly assessed. The aim of this study is to identify the risk factors for and evaluate the pattern of LTS in burned patients with inhalation injury. Subjects and Method：From May 2005 to April 2007, 227 burned patients with inhalation injury treated at the Hangang Sacred Heart Hospital, Hallym University Medical Center were investigated retrospectively. The risk factors analyzed for LTS in burned patients with inhalation injury were gender, age, duration of intubation, size of the endotracheal tube, previous tracheotomy, number of intubations, severity of inhalation injury. Results：Among 81 patients who survived and could be followed up until the study period, 10 (12%) patients developed LTS. The stenosis involved the subglottis·cervical trachea (5), subglottis·cervical tracheal and glottis (1), glottis (4). According to Myer-Cotton classification, there were 6 (60%) patients with grade III, IV stenoses on subglottis·cervical trachea. The number of intubations and previous tracheotomy were found to be risk factors for the development of LTS in burned patients with inhalation injury. Conclusion：LTS by inhalation injury is usually shown on web at the anterior and posterior glottic areas or circumferential narrowing of the subglottis. Repeated endotracheal intubations and previous tracheotomy in patients with inhalation injury may increase the prevalence of LTS. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1025-9)
Abstract
Laryngotracheal stenosis (LTS) in burned patients with inhalation injury have features distinct from other stenosis after intubation or tracheotomy. However, the risk factors for LTS in burned patients with inhalation injury have not been thoroughly assessed. The aim of this study is to identify the risk factors for and evaluate the pattern of LTS in burned patients with inhalation injury. Subjects and Method：From May 2005 to April 2007, 227 burned patients with inhalation injury treated at the Hangang Sacred Heart Hospital, Hallym University Medical Center were investigated retrospectively. The risk factors analyzed for LTS in burned patients with inhalation injury were gender, age, duration of intubation, size of the endotracheal tube, previous tracheotomy, number of intubations, severity of inhalation injury. Results：Among 81 patients who survived and could be followed up until the study period, 10 (12%) patients developed LTS. The stenosis involved the subglottis·cervical trachea (5), subglottis·cervical tracheal and glottis (1), glottis (4). According to Myer-Cotton classification, there were 6 (60%) patients with grade III, IV stenoses on subglottis·cervical trachea. The number of intubations and previous tracheotomy were found to be risk factors for the development of LTS in burned patients with inhalation injury. Conclusion：LTS by inhalation injury is usually shown on web at the anterior and posterior glottic areas or circumferential narrowing of the subglottis. Repeated endotracheal intubations and previous tracheotomy in patients with inhalation injury may increase the prevalence of LTS. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1025-9)
참고문헌 (20)
- Streitz JM, "Airway injury after tracheotomy and endotracheal intubation", Surg Clin North Am, 71(6), pp.1211~1230 (1991)
- Kim GR, "A study of the inhalation injury in Daegu subway fire accident in 2003", Korean J Burn, 6(2), pp.75~81 (2003)
- Hwang K, "Clinical analysis of the inhalation injury in great fire accident; Inhyun-dong, Inchon fire accident", Korean J Burn, 4(1), pp.24~28 (2001)
- Schneider W, "Diagnostic and therapeutic possibilities for fiberoptic bronchoscopy in inhalation injury", Burns Incl Therm Inj, 14(1), pp.53~57 (1988)
- Masanes MJ, "Using bronchoscopy and biopsy to diagnosis early inhalation injury. Macroscopic and histologic findings", Chest, 107(5), pp.1365~1369 (1995)
- 장재혁, "흡입화상환자에서 기관 내 점막의 병리조직학적 변화", 대한이비인후과학회지 두경부외과학, 50(5), pp.438~441 (2007), 대한이비인후과학회
- Myer CM, "Proposed grading system for subglottic stenosis based on endotracheal tube sizes", Ann Otol Rhinol Laryngol, 103(4), pp.319~323 (1994)
- Weymuller EA Jr, "Problems associated with prolonged intubation in the geriatric patient", Otolaryngol Clin North Am, 23(6), pp.1057~1074 (1990)
- Whited RE, "A prospective study of laryngotracheal sequelae in longterm intubation", Laryngoscope, 94(3), pp.367~377 (1984)
- Cho JS, "Etiology of the laryngotracheal stenosis", Korean J Bronchoesophagol, 1(1), pp.13~23 (1995)
- Grundfast KM, "Prospective study of subglottic stenosis in intubated neonates", Ann Otol Rhinol Laryngol, 99(5), pp.390~395 (1990)
- Jones R, "Subglottic stenosis in newborn intensive care unit graduates", Am J Dis Child, 135(4), pp.367~368 (1981)
- Nordin U, "Blood flow in the rabbit tracheal mucosa under normal conditions and the influence of tracheal intubation", Acta Anaesthesiol Scand, 21(2), pp.81~94 (1977)
- Kim JH, "The clinical aspects of toxic smoke inhalation injury in the closed space", Korean J Burn, 7(1), pp.6~10 (2004)
- Miller RP, "Airway reconstruction following laryngotracheal thermal trauma", Laryngoscope, 98(8), pp.826~829 (1998)
- Yang JY, "Symptomatic tracheal stenosis in burns", Burns, 25(1), pp.72~80 (1999)
- Jones WG, "Tracheostomies in burn patients", Ann Surg, 209(4), pp.471~474 (1989)
- Paul S, "The burned trachea", Chest surg Clin N Am, 13(2), pp.343~348 (2003)
- Fan LL, "Risk factors prediciting laryngeal injury in intubated neonates", Crit Care Med, 11(6), pp.431~433 (1983)
- Hoasjoe DK, "Posterior glottic stenosis mechanism and surgical management", Laryngoscope, 107(5), pp.675~679 (1997)