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声襞反常运动

Authors
Jo Shapiro, MD
Jayme Dowdall, MD
Chandler Thompson, DMA, MS, CCC-SLP
Section Editor
Peter J Barnes, DM, DSc, FRCP, FRS
Deputy Editor
Helen Hollingsworth, MD
Translators
王吉喆, 主任医师，教授

引言

声襞反常运动(paradoxical vocal fold motion, PVFM)描述的是真声襞的不恰当运动。PVFM指的是一种临床现象，而不是一个特定的或严格定义的临床诊断。PVFM最常观察到的表现是吸气中声襞的不恰当内收。在急诊室就诊时通常表现为哮鸣音、喘鸣、或明显的上气道梗阻。诊断延迟的情况很常见，采取不必要的治疗(如插管、气管造口术)的情况也不少见。患者通常频繁就医，并通常会持续很长一段时间[1]。

虽然早在19世纪00年代就有这种现象临床观察的描述，但在20世纪70年代和80年代，随着喉镜的应用增加，这种现象才开始越来越多的显现[2]。PVFM无意中成为了喉部功能障碍的一种统称[3]。然而，明确地将这种功能障碍定义为“功能受损”很重要，这强调其与心因性障碍不同。

本专题将总结PVFM的表现和治疗，PVFM又被称为喉肌运动障碍、声带功能障碍(vocal cord dysfunction, VCD)、声带反常运动(paradoxical vocal cord motion, PVCM)、吸气性内收、周期性发生的喉梗阻(periodic occurrence of laryngeal obstruction, POLO)、Munchausen喘鸣、阵发发作性喉痉挛、精神性喘鸣、功能性喘鸣、癔症性哮吼、情绪性喉哮鸣、人为性哮喘、假气喘以及喉易激综合征[2-5]。除PVFM之外的哮鸣性疾病的特征将单独讨论。 (参见“成人中哮喘以外的喘息性疾病的评估”和“青少年及成人哮喘的诊断”)

解剖发现

正常喉部的真声襞在吸气时外展或开放，在呼气时部分内收或关闭(图 1)。除吸气外，嗅闻和喘息也会引起声襞外展。真声襞的正常内收发生于发声、咳嗽、清嗓、吞咽和Valsalva动作(捏鼻鼓气)时。呼气时声襞内收大约10%-40%是正常的。正常咳嗽的机制包括吸气相结束后声襞内收0.2秒[6]。

PVFM可见于吸气时、呼气时，或在吸气时和呼气时均发生(图 1)[2,7,8]。假声襞和声门上组织也可能动态地压缩气道。喉镜检查中必须观察整个声襞外展的情况，以排除其他引起喉梗阻的原因。

                       

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Literature review current through: 2017-07 . | This topic last updated: 2016-08-15.
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