Tacquard Charles, Collange Olivier, Olland Anne, Dégot Tristan, Steib Annick
Pôle Anesthésie - Réanimations Chirurgicales - SAMU, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Can J Anaesth. 2014 Apr;61(4):357-61. doi: 10.1007/s12630-014-0114-0. Epub 2014 Jan 28.
To describe tracheal rupture after orotracheal intubation assisted by a tracheal tube introducer.
A 73-yr-old morbidly obese female patient with a history of hypertension underwent a total knee replacement. There were no anticipated signs of difficult intubation. Orotracheal intubation was attempted twice by direct laryngoscopy, and a Boussignac bougie was used as a tube exchanger for the second attempt. Seven hours after tracheal extubation, the patient became dyspneic and showed a large subcutaneous emphysema. A chest x-ray and computerized tomography scan revealed rupture of the posterior tracheal wall. The distal part of the injury was 26.5 cm from the patient's teeth and 0.5 cm from the carina (i.e., beyond the normal location of the tracheal tube tip) and extended to the origin of the right main bronchus, where the tip of the Boussignac bougie was probably pushed. Formation of an endotracheal sac occurred during the first two weeks after intubation, accompanied by dyspnea and alveolar hypoventilation, but symptoms resolved favourably with conservative management.
The tracheal rupture was attributed to airway manipulations, and the distal location of the lesion suggests that the cause was the Boussignac bougie rather than the tracheal tube. Long-term healing of the injury was satisfactory, although the patient continued to complain of dyspnea one year after the rupture.
描述在气管导管导入器辅助下经口气管插管后发生的气管破裂。
一名73岁、患有高血压的病态肥胖女性患者接受了全膝关节置换术。没有预料到存在插管困难的迹象。通过直接喉镜进行了两次经口气管插管尝试，第二次尝试时使用了布西尼亚克探条作为导管交换器。气管拔管7小时后，患者出现呼吸困难并伴有大面积皮下气肿。胸部X线和计算机断层扫描显示气管后壁破裂。损伤的远端距患者牙齿26.5 cm，距隆突0.5 cm（即超出气管导管尖端的正常位置），并延伸至右主支气管起始处，布西尼亚克探条的尖端可能在此处推进。插管后的前两周内形成了气管内囊肿，伴有呼吸困难和肺泡通气不足，但经保守治疗症状得到了良好缓解。
气管破裂归因于气道操作，病变的远端位置表明病因是布西尼亚克探条而非气管导管。尽管患者在破裂一年后仍持续抱怨呼吸困难，但损伤的长期愈合情况良好。
