経鼻胃管症候群を呈したパーキンソン病の2症例

Two Cases of Parkinson's Disease Accompanied with Nasogastric Tube Syndrome

経鼻胃管中に両側声帯麻痺をきたしたパーキンソン病（PD）の2例を経験した。両例とも胃管挿入後に吸気性の喘鳴と声帯外転麻痺をきたし，抜去により症状が寛解したため経鼻胃管症候群（NGTS）と診断した。本症は，経鼻胃管挿入後に咽頭痛と両側声帯麻痺をきたす稀な症候群であるが，時に致死的経過をたどる。その発症早期の徴候として咽頭痛が重要とされるが，進行期のPDでは自覚症状を確認することは困難と思われる。われわれはPDにNGTSを合併した既報告例を検索し，吸気性喘鳴がNGTSの診断における有用な他覚的徴候になるものと推察した。

Abstract

We report 2 cases of patients with Parkinson's disease who exhibited bilateral vocal cord paralysis induced by an indwelling nasogastric tube (N-G tube). Both patients showed abrupt inspiratory stridor after N-G tube placement. A fiberoptic laryngeal examination revealed bilateral vocal cord abductor paralysis (VCAP). After N-G tube removal, patient symptoms improved. Nasogastric tube syndrome (NGTS) is an uncommon but life-threatening syndrome that causes sore throat and bilateral VCAP following N-G tube insertion. Throat pain is considered an important early manifestation of NGTS. However, in cases of advanced Parkinson's disease, subjective symptoms of NGTS, such as throat pain, may be difficult to recognize. We here report 2 patients with parkinson's disease accompanied by NGTS with literature review and proposed that inspiratory strider is a useful objective symptom in early diagnosing of NGTS.

(Received March 25, 2020; Accepted May 18, 2020; Published September 1, 2020)