Unilateral Vocal Cord Paralysis following Endotracheal Intubation-A Case Report

氣管內管插管後發生之單側聲帶麻痺－病例報告

10.6955/AAS.199912.0221

呂亦雄(Yi-Hsiung Lu)；謝茂煒(Mao-Wei Hsieh)；唐於雄(Yu-Hsiung Tong)

術後併發症：聲帶麻痺 ； 氣管內管置入 ； Postoperative complication: vocal cord paralysis ； Intubation: intratracheal

Acta Anaesthesiologica Sinica

37卷4期（1999 / 12 / 01）

221 - 224

英文

一位41歲男性因罹患手汗症，安排進行胸腔內視鏡交感神經阻斷手術。在接受氣管內插管全身麻醉情況下，手術順利完成。然而於術後期間，病患抱怨聲音沙啞。經喉頻閃光源內視鏡檢查發現爲左側聲麻痺。 本病例之併發症，我們認爲是氣管內管插管造成的。可能的原因包括：氣管內管位置不當（置放時太淺或移動病患時內管外滑）與過高的氣管內管氣囊壓力。以上原因可造成喉返神經前枝之損傷，進而導致聲帶麻痺。我們同時一併討論聲帶麻痺之處理原則與預防之道。

A 41-year-old man of ASA physical status class I was scheduled to receive the video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris. The elective surgery was performed smoothly under general anesthesia with endotracheal intubation. However, the patient complained of hoarseness in the postoperative period. A stroboscopic examination showed that the left vocal cord remained stationary in the paramedian position, signifying left vocal cord paralysis. In the case, we believed it was most likely that endotracheal intubation might be responsible for the unilateral vocal cord paralysis. The possible cause was that during placement or thereafter during positioning, the endotracheal tube was malposed or slipped upward, rendering its inflated cuff to rest against the vocal cords. Another reason was that the cuff which was over inflated made the vocal cords under constant pressure. Both conditions may cause damage to the anterior branch of the recurrent laryngeal nerve. We also discussed the general managenent and prophylaxis for the unilateral vocal cord paralysis.