阵发性喉痉挛的临床特点分析

李雪岩; 徐文; 程丽宇

doi:10.13201/j.issn.1001-1781.2018.06.004

阵发性喉痉挛的临床特点分析

- 1. 首都医科大学附属北京同仁医院耳鼻咽喉头颈外科, 耳鼻咽喉头颈科学教育部重点实验室(首都医科大学)(北京, 100730)
基金项目:
北京市高层次卫生技术人才培养基金-学科带头人(No:2014-2-004)

详细信息

通讯作者: 徐文,E-mail:xuwendoc@126.com

中图分类号: R767.6

收稿日期: 2018-01-02

Analysis of clinical characteristics of paroxysmal laryngospasm

- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China

More Information

Corresponding author: XU Wen, E-mail: xuwendoc@126.com

Received Date: 02 January 2018

摘要

摘要: 目的:分析成人阵发性喉痉挛的临床特点。方法:回顾性分析149例成人阵发性喉痉挛的发病特征、症状、临床检查、治疗和预后。患者均行喉镜检查,完成反流量表评估(RSI/RFS)。选择部分患者行pH监测。结果:患者男73例,女76例;平均年龄(55.4±11.4)岁。146例(98%)患者喉痉挛持续数秒至数分钟不等;139例(93.3%)可自行缓解。84例(56.4%)患者喉痉挛仅于白天发作,37例(24.8%)患者全天均有发作,28例(18.8%)患者仅夜间发作。超重及肥胖者占45.6%(68/149),其中男40例,女28例。吸烟者占28.9%(43/149),其中男40例,女3例;饮酒者占29.5%(44/149),其中男39例,女5例。76例(51.0%)患者发作前无诱因,最多见诱因为刺激性咳嗽(呛咳)(53, 35.6%)。喉镜检查显示46.3%(69/149)患者合并有咽喉部病变,声门区病变40例(26.8%),还包括单侧声带运动不良21例(14.1%)和声门上病变8例(5.4%)。RSI/RFS量表咽喉反流阳性患者111例(74.5%)。单纯调整生活方式者随访2例治疗均有效,抑酸治疗者随访16例,15例治疗有效。结论:阵发性喉痉挛以日间发作为主,可自行缓解;超重或肥胖男性、有长期烟酒史男性更易发生;近半数患者存在诱因,部分患者合并咽喉部器质性病变;其发生可能与反流密切相关。
- 喉痉挛 /
- 咽喉反流 /
- 咽喉部病变
Abstract: Objective:To analyze the clinical characteristics of paroxysmal laryngospasm in adult.Method:A retrospective analysis was performed on 149 patients with paroxysmal laryngospasm in adult. All patients underwent the strobolaryngoscopy, completed the reflux symptom index (RSI) or the reflux finding score (RFS). Partial patients underwent an ambulatory 24-hour pH measurement.Result:Laryngospasm was diagnosed in 76 females and 73 males. The average age was 55.4±11.4. The episode time of 149 (98%) patients last from several seconds tominutes, and 139 (93.3%) episodes could have a spontaneous remission. 84 (56.4%) episodes occurred only in the daytime, 28 (18.8%) only in the nighttime. There were 45.6% over weight/obesity patients, including 40 males and 28 females. The smokers were 28.9% (43/149) including 40 males and 3 females, and the drinkers were 29.5% (44/149) with 39 males and 5 females. 76 (51.0%) patients had no induced factor, while some caused by irritable cough/bucking (53,35.6%), cold (15, 10.1%), excitant food/smell (10, 6.7%), or regurgitation (6.5, 4.0%). Strobolaryngoscopy revealed laryngopharyngeal lesions in 46.3% (69/149) patients, including the glottic lesions with 40 (26.8%), unilateral vocal fold paralysis (21, 14.1%) and supraglottic lesions (8,5.4%). RSI/RFS showed 74.5% (111/149) patients had laryngopharyngeal reflux. Two patients treated with dietary and lifestyle modifications get improved, and 15/16 of the patients responded to antireflux treatment.Conclusion:Episode of paroxysmal laryngospasm occurs more in the daytime, and could have a spontaneous resolution. Paroxysmal laryngospasm is much easier to occur in the male who are overweight or obesity, or with a long-term history of smoking or drinking. Almost half of the patients have an induced factor, partial may have laryngopharyngeal lesions simultaneously. Paroxysmal laryngopharyngeal reflux may be closely related to laryngospasm.
- laryngospasm /
- laryngopharyngeal reflux /
- laryngopharyngeal lesions

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参考文献(13)

[1]	GDYNIA H J, KASSUBEK J, SPERFELD A D.Laryngospasm in neurological disease[J].Neurocrit Care, 2006, 4:163-167.
[2]	BELAFSKY P C, POSTMA G N, KOUFMAN J A.The validity and reliability of the reflux symptom index (RSI)[J].J Voice, 2002, 16:274-276.
[3]	BELAFSKY P C, POSTMA G N, KOUFMAN J A.The validity and reliability of the reflux finding score (RFS)[J].Laryngoscope, 2001, 111:1313-1317.
[4]	AYAZI S, LIPHAM J C, HAGEN J A, et al.A new technique for measurement of pharyngeal pH:normal values and discriminating pH threshold[J].J Gastrointest Surg, 2009, 13:1422-1429.
[5]	WHO.Obesity:preventing and managing the global epidemic.Report of a WHO consultation[J].World Health Organ Tech Rep Ser, 2000, 894:1-253.
[6]	LOUGHLIN C J, KOUFMAN J A.Paroxysmal laryngospasm secondary to gastroesophageal reflux[J].Laryngoscope, 1996, 106:1502-1505.
[7]	POELMANS J, TACK J, FEENSTRA L.Paroxysmal laryngospasm a typical but underrecognized supraesophageal manifestation of gastroesophageal reflux[J]?Dig Dis Sci, 2004, 49:1868-1874.
[8]	MACERI D R, ZIM S.Laryngospasm:an atypical manifestation of severe gastroesophageal reflux disease (GERD)[J].Laryngoscope, 2001, 111:1976-1979.
[9]	PINDER D, MCDONALD S E, MEDCALF M, et al.Idiopathic laryngeal spasm management and longterm outcome[J].Eur Arch Otorhinolaryngol, 2007, 264:159-162.
[10]	杨瑞, 王合彬.胃食管反流相关性喉痉挛9例诊治分析[J].中华实用诊断与治疗杂志, 2013, 27 (7):720-721.
[11]	OBHOLZER R J, NOURAEI S A, AHMED J, et al.An approach to the management of paroxysmal laryngospasm[J].J Laryngol Otol, 2008, 122:57-60.
[12]	CIORBA A, BIANCHINI C, ZUOLO M, et al.Upperaerodigestive tract disorders and gastro-oesophageal reflux disease[J].World J Clin Cases, 2015, 3:102-111.
[13]	WANI M K, WOODSON G E.Paroxysmal laryngospasm after laryngeal nerve injury[J].Laryngoscope, 1999, 109:694-697.