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[医源性气管破裂后气道的保守治疗]

[Conservative management of the airway following iatrogenic tracheal rupture].

作者信息

Vidal M C, Vázquez E, Tercedor A, Guzmán E, Cuesta P, Galán M

机构信息

Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de las Nieves, Granada.

出版信息

Rev Esp Anestesiol Reanim. 2007 Apr;54(4):246-9.

Abstract

The trachea of a 39-year-old man ruptured following intubation for fiberoptic bronchoscopy; the complication became evident during surgery as extensive subcutaneous emphysema developed. The emphysema resolved with conservative treatment. Tracheobronchial lesions are generally caused by direct trauma to the chest. Tracheal rupture due to intubation maneuvers is one of the complications anesthetists fear most. Although infrequent, such lesions are potentially fatal. Signs and symptoms can vary widely, from self-limiting asymptomatic subcutaneous emphysema immediately following surgery to severe complications such as tension pneumothorax, acute respiratory failure, pneumomediastinum, or even pneumopericardium. The absence of complications in patients treated conservatively has increased interest in using this approach to management when conditions are favorable, always with fiberoptic assessment to evaluate whether the lesion has resolved completely and without sequelae.

摘要

一名39岁男性在接受纤维支气管镜检查插管后气管破裂;手术过程中,随着广泛的皮下气肿出现,并发症变得明显。经保守治疗,气肿得以消退。气管支气管病变通常由胸部直接创伤引起。插管操作导致的气管破裂是麻醉医生最担心的并发症之一。尽管此类病变并不常见,但具有潜在致命性。其体征和症状差异很大,从术后立即出现的自限性无症状皮下气肿到严重并发症,如张力性气胸、急性呼吸衰竭、纵隔气肿,甚至心包积气。保守治疗患者未出现并发症,这使得人们在条件允许时,对采用这种治疗方法更感兴趣,同时始终要通过纤维支气管镜评估来判断病变是否已完全消退且无后遗症。

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