Agarwal Arpan, Nakao Masakazu, Rajadurai Victor Samuel, Chandran Suresh
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore.
BMJ Case Rep. 2017 Apr 13;2017:bcr-2016-218818. doi: 10.1136/bcr-2016-218818.
Intubating newborn infants can be exacting. We describe two cases of endotracheal intubations in infants born with tracheal malformations. A male infant aged 30 weeks required intubation at birth for respiratory distress. Repeated attempts at intubation failed to achieve an optimal endotracheal tube position as the tube could not advance beyond the vocal cords. Hence ventilation continued with suboptimal air entry in the lungs. Bronchoscopy and CT scan confirmed tracheal stenosis. Slide tracheoplasty was successfully executed on day 78 of life. A female infant aged 33 weeks was intubated at birth for perinatal depression. Attempts at intubation were unsuccessful due to non-visualisation of the laryngeal inlet. Oesophagus was intubated and attempts to inflate showed air entry in the lungs, suggesting a fistulous communication between oesophagus and airway. A contrast oesophagogram showed a fistula connecting oesophagus and carina. With airway patency in question and associated major anomalies, parents were counselled and support was withdrawn.
给新生儿插管可能很棘手。我们描述了两例患有气管畸形的新生儿气管插管病例。一名30周大的男婴出生时因呼吸窘迫需要插管。多次插管尝试均未能使气管导管达到最佳位置，因为导管无法越过声带。因此，肺部通气时空气进入情况欠佳。支气管镜检查和CT扫描证实为气管狭窄。在出生后第78天成功进行了滑动气管成形术。一名33周大的女婴出生时因围产期抑郁而插管。由于无法看到喉入口，插管尝试未成功。食管被插管，充气尝试显示肺部有空气进入，提示食管与气道之间存在瘘管相通。食管造影显示有瘘管连接食管和隆突。鉴于气道通畅情况存疑且伴有严重畸形，已向家长提供咨询并停止了支持治疗。
