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中央气道阻塞的诊断与处理

Authors
Armin Ernst, MD, FCCP
Felix JF Herth, MD, PhD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD
Translators
黎友伦, 主任医师

引言

中央气道阻塞可继发于一些良性和恶性病变(表 1)[1]。患者症状可能突然发生(如异物阻塞)也可逐渐发生(如大多数恶性阻塞)。在许多情况下，患者被误诊为哮喘或慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)，从而延误疾病的识别和治疗。

是否有经验丰富的医疗人员和医疗设备对于中央气道阻塞的干预选择存在影响。此外，患者病情的稳定性、基础疾病的性质以及患者的总体预后和生活质量也会影响干预的选择[1-5]。在具有擅长评估和处理受损气道的专业多学科综合医疗团队的医疗中心，可以为该病的处理提供最广泛的选择。

中央气道阻塞的诊断和一般处理方法将总结在此。具体的处理方式将单独详细讨论。

诊断

气道严重受损的标志是氧合和通气障碍。轻微阻塞的患者因气流受限较轻而通常无症状。然而，如果在呼吸道感染期间，水肿和分泌物增加了管腔压迫程度，则气道阻塞可快速恶化。气道阻塞尚未达到临界状态的患者被误诊为哮喘发作或COPD而真正病因是解剖学气道阻塞的情况并不少见。气道阻塞的患者也常常表现为肺炎；如果症状和/或影像学检查所示浸润在4-6周内没有消退，则应考虑行支气管镜检查。 (参见“无反应性肺炎”)

当气流受限达到临界值时，患者会出现症状和体征。患者会诉呼吸急促，这种呼吸急促常持续存在且支气管扩张剂治疗无效。患者可能存在单音调性哮鸣音，如果病变在气管隆嵴远端则该哮鸣音可出现在单侧。喘鸣是声门下或气管严重阻塞的体征。在病变晚期呼吸会变得困难，这预示着即将发生呼吸衰竭。

             

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Literature review current through: 2017-07 . | This topic last updated: 2016-03-17.
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