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禁忌使用发声阀后出现致命性双侧气胸和广泛性肺气肿。

Fatal bilateral pneumothorax and generalized emphysema following contraindicated speaking-valve application.

作者信息

Heimer Jakob, Eggert Sebastian, Fliss Barbara, Meixner Eva

机构信息

Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.

出版信息

Forensic Sci Med Pathol. 2019 Jun;15(2):239-242. doi: 10.1007/s12024-019-00107-4. Epub 2019 Mar 23.

Abstract

We report a case of a contraindicated attachment of a speaking valve to a tracheal tube with an inflated cuff, which rapidly resulted in the patient's death. The attached one-way valve allowed unrestrained inspiration through the tracheal tube but prevented physiological expiration. The increased pulmonary pressure resulted in alveolar rupture and replaced expiration with a steady release of air into the peribronchial sheaths and the mediastinum, resulting in what is commonly known as the Macklin effect. From the mediastinum, air inflated both pleural cavities, the peritoneum, and the subcutaneous tissue of the entire body. No gas was found in the blood vessels, the brain, the bones, or in the inner organs. The entire air volume was estimated by radiological segmentation to be more than 25 l. This implies continuous inspiration, while expiration turned into an aberrant pulmonary decompression by whole-body gas-enclosure. Death ultimately resulted from asphyxia following bilateral (tension) pneumothorax.

摘要

我们报告了一例将发声阀禁忌地连接到带有充气袖带的气管导管上的病例,这迅速导致了患者死亡。所连接的单向阀允许空气不受限制地通过气管导管吸入,但阻止了生理性呼气。肺内压力升高导致肺泡破裂,使呼气被空气持续释放到支气管周围鞘膜和纵隔所取代,从而产生了通常所说的麦克林效应。空气从纵隔进入,使双侧胸腔、腹膜和全身皮下组织膨胀。在血管、大脑、骨骼或内脏中未发现气体。通过放射学分割估计,整个空气量超过25升。这意味着持续吸气,而呼气则通过全身气体包裹变成了异常的肺减压。死亡最终是由双侧(张力性)气胸导致的窒息所致。

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