Matsuda N, Nakamura T, Morimoto Y, Kemmotsu O
Department of Anesthesiology, Hokkaido University, School of Medicine, Sapporo.
Masui. 2000 Apr;49(4):428-31.
Minitracheotomy is a useful procedure for the respiratory management of patients with sputum retention observed frequently in chronic lung disease and postoperative respiratory failure. However, we experienced a case of hypercapnea after minitracheotomy. An 83-year-old woman was scheduled for gastrectomy. She had respiratory failure of Hugh-Jones 5 with fibroid lungs and the infection with atypical Mycobacterium and MRSA. Her sputum was adhesive and showed persistent increase during pre- and intra-operative periods. After the operation, minitracheotomy was carried out against the sputum retention by using Portex Mini-Trach II kit. Hypercapnea, however, was observed in spite of no evidence of the surgical complications such as bleeding or inadequate care for sputum from the inserted tube. Bronchofiberscope revealed adhesive sputum stuck to the space between the inserted tube and the trachea. In this case, hypercapnea was improved by opening the top of the inserted tube and frequent care for sputum. In cases with a large amount of adhesive sputum, sputum retention may easily occur not only at the peripheral bronchial branch but also between the inserted tube and the trachea and it can cause hypercapnea which may be overlooked.
微创气管切开术是一种用于呼吸管理的有用方法，常用于慢性肺病和术后呼吸衰竭患者中经常出现的痰液潴留情况。然而，我们遇到了一例微创气管切开术后出现高碳酸血症的病例。一名83岁女性计划接受胃切除术。她患有Hugh-Jones 5级呼吸衰竭，伴有纤维化肺，感染了非典型分枝杆菌和耐甲氧西林金黄色葡萄球菌。她的痰液黏稠，在术前和术中持续增多。术后，使用Portex Mini-Trach II套件针对痰液潴留进行了微创气管切开术。然而，尽管没有手术并发症的证据，如出血或对插入管痰液处理不当，但仍观察到了高碳酸血症。纤维支气管镜检查显示，黏稠痰液附着在插入管与气管之间的间隙。在该病例中，通过打开插入管顶部并频繁进行痰液处理，高碳酸血症得到了改善。在痰液黏稠量较大的情况下，痰液潴留不仅容易发生在外周支气管分支处，还可能发生在插入管与气管之间，并且可能导致高碳酸血症，而这可能被忽视。
