Bhojani Rehal A, Rosenbaum David H, Dikmen Erkan, Paul Michelle, Atkins B Zane, Zonies David, Estrera Aaron S, Wait Michael A, Meyer Dan M, Jessen Michael E, DiMaio J Michael
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):426-32. doi: 10.1016/j.jtcvs.2004.12.020.
Laryngotracheal trauma is a rare and potentially deadly spectrum of injuries. We sought to characterize the contemporary mechanisms, diagnostic modalities, and outcomes common in laryngotracheal trauma today.
We performed a retrospective analysis of all laryngotracheal trauma cases at 2 major metropolitan hospitals between 1996 and 2004, detailing mechanisms, associated injuries, diagnostic modalities, and outcomes of laryngotracheal trauma.
We identified 71 patients with a mean age of 32.8 +/- 13.3 years (range, 15-71 years). In our series penetrating trauma was the cause in 73.2% of patients; however, blunt trauma had a significantly higher mortality (63.2% vs 13.5%, respectively; P < .0001). Blunt mechanisms involved older patients (38.5 +/- 15.2 years vs 30.1 +/- 11.9 years, P = .017), and these patients were more likely to require emergency airways than those with penetrating trauma (78.9% vs 46.2%, P = .017). The requirement of an emergency airway was an independent predictor of mortality (P = .0066).
Laryngotracheal trauma is a deadly spectrum of injuries with a mortality of 26.8%. Blunt mechanisms are decreasing in frequency. This might reflect improvements in automobile safety. Additionally, violent crime is on the increase, producing penetrating injuries with increasing frequency. The most fundamental intervention for patients with laryngotracheal injury is airway control. Either routine intubation or a tracheostomy can secure the airway. Blunt trauma and the requirement of an emergency airway are independent predictors of mortality. Laryngotracheal trauma requires prompt recognition, airway protection, and skillful management to lessen the mortality of this deadly spectrum of injuries.
喉气管创伤是一种罕见且可能致命的损伤类型。我们试图描述当今喉气管创伤常见的当代机制、诊断方式及结果。
我们对1996年至2004年间两家大型都市医院的所有喉气管创伤病例进行了回顾性分析，详细记录了喉气管创伤的机制、相关损伤、诊断方式及结果。
我们确定了71例患者，平均年龄为32.8±13.3岁（范围15 - 71岁）。在我们的系列研究中，73.2%的患者病因是穿透性创伤；然而，钝性创伤的死亡率显著更高（分别为63.2%和13.5%；P <.0001）。钝性创伤机制涉及年龄较大的患者（38.5±15.2岁对30.1±11.9岁，P = 0.017），并且这些患者比穿透性创伤患者更有可能需要紧急气道（78.9%对46.2%，P = 0.017）。紧急气道需求是死亡率的独立预测因素（P = 0.0066）。
喉气管创伤是一种死亡率为26.8%的致命损伤类型。钝性创伤机制的发生率在下降。这可能反映了汽车安全性的提高。此外，暴力犯罪在增加，导致穿透性损伤的频率不断上升。对喉气管损伤患者最基本的干预措施是气道控制。常规插管或气管切开均可确保气道安全。钝性创伤和紧急气道需求是死亡率的独立预测因素。喉气管创伤需要及时识别气道保护和熟练管理，以降低这种致命损伤类型的死亡率。
