PDF(Pubmed)
Abstract：
Rheumatoid arthritis (RA) can cause a number of laryngeal manifestations; however, most of these do not cause an airway emergency. Airway obstruction due to vocal cord fixation of one or both vocal cords occurs late in the disease process of RA and can present as an inspiratory stridor. We report the case of an elderly lady who presented with acute stridor secondary to RA-induced bilateral vocal cord palsy and describe the various management options that were considered. An 85-year-old woman presented to A&E Resus with tachypnoea, stridor, and drowsiness. An arterial blood gas (ABG) was performed which showed hypercapnic respiratory failure on 60% oxygen with blood tests revealing moderately raised infective markers and a chest X-ray displaying right lower zone consolidation. A flexible nasendoscopy was performed which demonstrated bilaterally fixed and adducted vocal cords due to bilateral cricoarytenoid joint fixation, with a rima glottidis measurement of approximately 3 mm and evidence of paradoxical breathing. The patient had been admitted with a similar presentation 18 months before, however not as severe, and once again, the bilateral vocal cord palsy had been attributed to her longstanding RA. She was stabilised with non-invasive ventilation and transferred to the acute respiratory care unit. Long-term surgical options were thoroughly discussed including tracheostomy, vocal cord lateralisation, cordotomy, and arytenoidectomy, but ultimately, these options were all deemed unsuitable for the patient and so a palliative care approach was adopted following the withdrawal of bilevel positive airway pressure. Stridor is a late but life-threatening complication of RA that has viable surgical options of tracheostomy and static glottis enlarging procedures; however, the appropriateness of such procedures should always be correlated with the patient\'s current clinical status and the extent to which they may impact on the patient\'s quality of life.
摘要：
类风湿性关节炎（RA）可引起许多喉部表现；然而，其中大多数不会引起呼吸道急症。由于一个或两个声带的声带固定引起的气道阻塞发生在RA疾病过程的后期，并且可以表现为吸气性喘鸣。我们报告了一位老年女士的病例，该女士出现了RA引起的双侧声带麻痹继发的急性喘鸣，并描述了考虑的各种治疗方案。一名85岁的妇女出现呼吸急症室，stridor,和困倦。进行了动脉血气（ABG）检查，显示60％氧气下的高碳酸血症性呼吸衰竭，血液检查显示感染标志物中度升高，胸部X射线显示右下区域巩固。进行了柔性鼻内窥镜检查，显示由于双侧环蝶骨关节固定，双侧固定和内收的声带，声门的测量值大约为3毫米，有反常呼吸的证据。该患者在18个月前以类似的表现入院，然而没有那么严重，再一次,双侧声带麻痹归因于她长期的RA.她通过无创通气稳定下来，并转移到急性呼吸护理单元。彻底讨论了长期的手术选择，包括气管造口术，声带偏侧化，脊髓切开术,和动脉粥样硬化切除术,但最终，这些选择都被认为不适合患者,因此在停用双水平气道正压后采用姑息治疗方法.Stridor是RA的晚期但危及生命的并发症，具有可行的气管造口术和静态声门扩大手术的手术选择；然而，此类手术的适当性应始终与患者的当前临床状态以及它们可能对患者生活质量的影响程度相关。
