Cavinato Simon Robert, Denning Mike, Madden Brendan P
Department of Cardiothoracic Intensive Care, Saint George's Healthcare NHS Trust, London, UK.
Saint George's Healthcare NHS Trust, London, UK.
BMJ Case Rep. 2017 Feb 24;2017:bcr2016218948. doi: 10.1136/bcr-2016-218948.
A man aged 51 years was referred for tracheobronchial stenting after a poorly differentiated oesophageal carcinoma had progressed to cause stridor. Bronchoscopy revealed a left vocal cord palsy and tumour infiltration into the trachea. A tracheobronchial stent was placed, and after distal migration was endoscopically resited. Returning from theatre, the patient developed severe upper airway obstruction that progressed to cause CO narcosis and loss of consciousness. A rapid sequence induction was initiated, and a Glidescope revealed bilateral vocal cord palsy with severe oedema causing an inability to pass a tube or stylet. Tracheostomy was attempted above the suprasternal notch but was obstructed by the stent. Oxygen saturations dropped steadily, reaching as low as 38%. Emergency cricothyroidotomy was performed, compliant with DAS guidelines, that proved successful. The stent was removed, which was blocked with blood and secretions, and tracheostomy was placed 2 days later. The patient made a full neurological recovery.
一名51岁男性因低分化食管癌进展导致喘鸣而被转诊进行气管支气管支架置入术。支气管镜检查显示左侧声带麻痹以及肿瘤浸润至气管。放置了气管支气管支架，之后支架向远端移位，通过内镜重新调整了位置。患者从手术室返回后，出现严重的上气道梗阻，进而发展为一氧化碳麻醉和意识丧失。启动了快速顺序诱导，使用Glidescope喉镜发现双侧声带麻痹并伴有严重水肿，导致无法插入气管导管或管芯。尝试在胸骨上切迹上方进行气管切开术，但被支架阻挡。血氧饱和度持续下降，低至38%。按照困难气道协会（DAS）指南进行了紧急环甲膜切开术，手术成功。取出被血液和分泌物堵塞的支架，两天后进行了气管切开术。患者神经功能完全恢复。
