上气道阻塞76例临床分析

目的探讨上气道阻塞的特点,提高对上气道阻塞的认识和早期诊断率。方法回顾性分析2004年1月～2007年4月间在北京协和医院确诊为上气道阻塞的76例患者的病因谱、临床特点、肺功能、纤维支气管镜下表现及病理学特点。结果76例患者中,呼吸道淀粉样变19例(25.0%),复发性多软管炎23例(30.3%),肿瘤25例(32.9%),结核8例(10.5%),甲状腺多发实性结节1例(1.3%)。上气道阻塞的临床表现多种多样,主要症状包括:咳嗽46例(60.5%)、声音嘶哑43例(56.6%)、不同程度的呼吸困难36例(47.4%)和咯痰29例(38.2%)。56例患者进行了肺通气功能检查,其中27例(48.2%)表现为阻塞性通气功能障碍,14例(25.0%)表现为混合性通气功能障碍。70例患者进行了支气管镜或喉镜检查,67例(95.7%)有明显异常发现,其中35例患者(50%)表现为气管、支气管壁增厚和/或狭窄,32例患者(45.7%)表现为气管内结节或新生物。60例进行病理学检查的患者中,符合淀粉样变者16例,复发性多软骨炎5例,结核4例,肿瘤25例,支气管黏膜肉芽肿伴慢性炎症10例。结论对于临床怀疑上气道阻塞的患者应及时行肺功能、纤维支气管镜检查,有助于上气道阻塞的早期诊断与治疗。

Clinical analysis of 76 patients with upper airway obstruction

Objective To explore the clinical characteristics of upper airway obstruction(UAO).Methods We retrospectively analyzed the clinical data of 76 UAO patients who had been treated in Peking Union Medical College Hospital from January 2004 to April 2007.Results Among these 76 UAO patients,the clinical diagnoses included pulmonary amyloidosis(n=19,25.0%),relapsing polychondritis(n=23,30.3%),tumor(n=25,32.9%),and tuberculosis(n=10,13.0%).Clinical manifestations included chronic persistent cough(n=46),dyspnea(n=36),hoarseness(n=43),and productive cough(n=29).Among 56 patients who underwent pulmonary function test,27 patients had obstructive ventilatory disturbance pattern and 14 had mixed disturbance pattern.Among 70 patients who underwent bronchoscopy,67 patients had pathological abnormalities from severe airway mucosal inflammation,tracheobronchial cartilage destruction,and tracheobronchial wall collapse(n=35)to neoplasms(n=32).Among 60 patients who underwent pathological examinations,the pathological changes were consistent with amyloidosis(n=16),relapsing polychondritis(n=5),tuberculosis(n=4),tumors(n=25),or chronic granulomatous inflammation of mucosa(n=10).Conclusion Careful and prompt pulmonary function test and bronchoscopy are helpful for early diagnosis and treatment of UAO.