長期經口氣管插管在口腔、咽、喉及氣管之合併症

Oral, Pharyngeal, and Laryngotracheal Complications after Prolonged Oral Endotracheal Intubation

氣管插管在急重症單位是一常見且重要的技術，其對人體的傷害不僅發生於插管的當下，亦會在往後管路的留置期間逐漸產生。長期插管會在呼吸道造成多處損傷，症狀輕者如喉嚨疼痛、聲音沙啞，重者則導致氣管軟化、呼吸道阻塞等致命情況。本文將介紹長期插管（大於48 小時）造成口腔、咽喉至氣管的損傷，包含表皮黏膜損傷、水腫、牙齒損傷、聲帶麻痺、接觸性肉芽腫、吞嚥困難、氣管軟化、氣管食道廔管等，其中聲帶麻痺、接觸性肉芽腫、氣管軟化、氣管食道廔管等與過高的氣管內管氣囊壓力有關，使用壓力計定期監測及記錄氣囊壓力，維持氣囊壓力在20-30 cm H2O 間，可降低此類合併症的發生。

The complications of oral intubation vary from minor symptoms to fatal complications. The aim of this report was to briefly review the common oral and laryngotracheal complications of prolonged endotracheal intubation, including mucosal erosions/ulcers, oropharyngeal edema, dental injuries, vocal cord paralysis, dysphagia, granuloma, tracheomalacia, and tracheoesophageal fistula. In line with literature, we defined prolonged endotracheal intubation as 48 hours or longer. We hope by increasing the awareness among healthcare professionals, early detection and intervention could be implemented to prevent or reduce the severity of these complications following prolonged endotracheal intubation.