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甲状腺切除术后危及生命的血肿的气道管理

Airway management of a life-threatening post-thyroidectomy haematoma.

作者信息

Adigbli George, King Jonathan

机构信息

Department of Surgery, University College London Hospitals NHS Foundation Trust, London, UK.

Department of Medicine, Northwick Park Hospital, London, UK.

出版信息

BMJ Case Rep. 2015 Dec 15;2015:bcr2015213578. doi: 10.1136/bcr-2015-213578.

Abstract

Neck haematomas are rare but potentially life-threatening complications of thyroid surgery. Postoperative monitoring, early diagnosis and immediate management are critical, as this condition can rapidly lead to compression and obstruction of the upper airway. We present a case of a 69-year-old woman who suffered respiratory failure resulting from a post-thyroidectomy haematoma with airway obstruction and severe haemodynamic compromise, presenting a difficult anaesthetic challenge. Following development of a likely 'cannot intubate, cannot ventilate' situation despite haematoma evacuation, the patient underwent emergency cricothyroidotomy, before rapid sequence intubation and subsequent surgical haemostasis.

摘要

颈部血肿是甲状腺手术罕见但可能危及生命的并发症。术后监测、早期诊断和立即处理至关重要,因为这种情况可迅速导致上呼吸道受压和阻塞。我们报告一例69岁女性病例,该患者因甲状腺切除术后血肿导致气道阻塞和严重血流动力学不稳定而发生呼吸衰竭,给麻醉带来了严峻挑战。尽管进行了血肿清除,但仍出现了可能的“无法插管、无法通气”情况,随后患者接受了紧急环甲膜切开术,之后进行快速顺序插管及后续手术止血。

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