Acute epiglottitis in adults: The Royal Melbourne Hospital experience
Acute epiglottitis in adults: The Royal Melbourne Hospital experience
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DOI：
10.1046/j.1445-1433.2001.02265.x
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发表时间：
2001-12-01
影响因子：
1.7
通讯作者：
Berkowitz, RG
中科院分区：
文献类型：
--
作者：
Wong, EYH;Berkowitz, RG
背景：探讨成人急性会厌炎的常见表现和治疗方法。方法：对 1988 年 1 月至 2000 年 12 月期间到皇家墨尔本医院就诊的连续 17 名成人患者进行回顾性临床研究。结果：患者平均年龄为 47 岁（范围 20-87 岁），男女比例为 1.8：1.0。发病高峰出现在早春的九月。所有患者均出现咽痛和吞咽困难；然而，只有 65% 的人注意到呼吸困难。最常见的症状是体温和心动过速。 4 名患者 (23%) 需要气管插管，其中 3 名患者需要进行气管插管，1 名患者需要紧急进行气管插管。 14 份血培养中有 3 份呈阳性，其中 2 份检出 b 型流感嗜血杆菌，1 份检出轻链球菌。四种咽喉培养物之一呈 b 型流感嗜血杆菌阳性。作为初步评估的一部分，12 名患者在表面麻醉下接受了清醒的柔性喉镜检查，并且没有与该手术相关的并发症。没有死亡。结论：成人急性会厌炎的诊断很困难，因为可能不存在呼吸窘迫。患有明显喉咙痛且无明显病因的患者应通过软喉镜直接观察其喉部。颈部侧位X线检查价值有限。一旦确诊，这些患者应住院并进行监测，因为气道阻塞可能会迅速发展。
Background: To examine the common presentations and management of acute epiglottitis in adults.Methods: Retrospective clinical study of 17 consecutive adult patients who presented to the Royal Melbourne Hospital between January 1988 and December 2000 was undertaken.Results: The mean patient age was 47 years (range 20-87 years) and the male-to-female ratio was 1.8 : 1.0. Peak incidence occurred in September during early spring. All patients presented with sore throat and dysphagia; however, respiratory distress was only noted in 65%. The most common signs were temperature and tachycardia. Four patients (23%) required endotracheal intubation, which was performed electively in three and as an emergency in one. Three of 14 blood cultures were positive, two yielded Haemophilus influenzae type b and one yielded Streptococcus mitis. One of the four throat cultures was positive for Haemophilus influenzae type b. Twelve patients underwent awake flexible laryngoscopy under topical anaesthetic as part of their initial assessment, and there were no complications associated with this procedure. There was no mortality.Conclusions: The diagnosis of acute epiglottitis in the adult population is difficult as respiratory distress may be absent. Patients who have a significant sore throat with no obvious aetiology should have direct visualization of their larynx by flexible laryngoscopy. Lateral X-ray of neck is of limited value. Once diagnosed, these patients should be hospitalized and monitored as airway obstruction may develop rapidly.