Devaraja K, Nayak Dipak Ranjan, Kordcal Abhishek Rao, Malapure Sumeet Suresh
Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Anasethesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
BMJ Case Rep. 2018 Sep 25;2018:bcr-2018-226639. doi: 10.1136/bcr-2018-226639.
Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4 hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical-biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins' compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing's reflex would at least contribute partly, if not solely to the respiratory distress.
甲状腺手术后颈部血肿可表现为呼吸窘迫，这通常归因于气道阻塞。我们最近有一位63岁的女性患者，因毒性结节性甲状腺肿接受了全甲状腺切除术。然而，术后4小时内，她突然出现呼吸窘迫，通过及时排出颈部血肿得以处理。就在血肿排出前，患者除了呼吸窘迫外，还出现了高血压和心动过缓。当时采集的动脉血气分析结果正常。术中发现气管结构僵硬且不易弯曲。考虑到观察到的各种临床生化结果，我们认为该病例中呼吸窘迫的原因是双侧颈内静脉受压继发的颅内压短暂升高。我们推测，在许多术后立即出现颈部血肿的患者中，库欣反射至少部分（如果不是唯一）导致了呼吸窘迫。
