Metcalf Kathryn B, Michaels Andrew J, Edlich Richard F, Long William B
Legacy Emanuel Shock Trauma Center, Portland, Oregon, USA.
J Emerg Med. 2013 Sep;45(3):380-3. doi: 10.1016/j.jemermed.2013.03.017. Epub 2013 Jun 12.
Sand aspiration occurs in situations of cave-in burial and near-drowning. Sand in the tracheobronchial airways adheres to the mucosa and can cause tracheal and bronchial obstruction, which can be life-threatening even with intensive management. In previous case reports of airway obstruction caused by sand aspiration, fiber optic or rigid bronchoscopy has been effective in removing loose sand, but removal of sand particles lodged in smaller airways has proven challenging and time-consuming.
In this case report of sand aspiration with acute pulmonary failure, the use of extracorporeal membrane oxygenation for respiratory support allowed more effective removal of sand particles by rigid bronchoscopy and lavage with less patient compromise.
Our case of sand aspiration is unique in that the patient presents with complex medical problems (mixed respiratory and metabolic acidosis), hypothermia, hypoxemia, and neoplastic conditions. The fact that she survived the sand aspiration and a long inter-hospital transport time (90 min) with inadequate ventilation and oxygenation without apparent ill effects suggests that the measures we took to resuscitate her and extract the sand from her airways were reasonable and appropriate.
沙粒吸入发生在塌方掩埋和近乎溺水的情况下。气管支气管气道中的沙粒会附着在黏膜上，可导致气管和支气管阻塞，即使经过强化治疗也可能危及生命。在先前关于沙粒吸入导致气道阻塞的病例报告中，纤维支气管镜或硬质支气管镜在清除松散沙粒方面有效，但清除滞留在较小气道中的沙粒已证明具有挑战性且耗时。
在这份关于沙粒吸入伴急性肺衰竭的病例报告中，使用体外膜肺氧合进行呼吸支持，使得通过硬质支气管镜更有效地清除沙粒并进行灌洗，同时对患者的损害更小。
我们的沙粒吸入病例具有独特性，因为患者存在复杂的医学问题（混合性呼吸和代谢性酸中毒）、体温过低、低氧血症和肿瘤疾病。她在沙粒吸入以及长达90分钟的院间转运期间，通气和氧合不足，但却存活下来且未出现明显不良影响，这表明我们为抢救她并从气道中清除沙粒所采取的措施是合理且恰当的。
