Huang Y F, Zhang Z, Chen B, Liu C L, Li G Q, Tang E Q, Li X J
Clinical School of Guizhou Medical University, Guiyang 550004, China.
Clinical School of Guizhou Medical University, Guiyang 550004, China(is now working at the Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital, Guangzhou 510220, China).
Zhonghua Shao Shang Za Zhi. 2020 Sep 20;36(9):880-882. doi: 10.3760/cma.j.cn501120-20190715-00299.
In November 4, 2016, a 1 year and 3 months old male patient with face and neck scald complicated with severe scald of oropharynx was admitted to Guangzhou Red Cross Hospital 1 hour after injury. The child developed upper respiratory tract obstruction 2 hours after injury, therefore tracheotomy and intubation were performed immediately to establish an artificial airway, and symptomatic treatments such as anti-infection, fluid replacement, and dressing change were conducted. On the 10th day after injury, the child had difficult breathing during the test tube blocking before extubation, and it was difficult to extubate. Symptomatic treatments such as ventilator assisted ventilation and strengthened anti-infection were continued. On the 17th day after injury, extubation plan was adjusted. Thirty minutes before extubation, phenobarbital was injected intramuscularly for sedation, and atropine was used to reduce airway secretions, after which extubation was successful. After 21 days of treatment, the child was cured and discharged. In the treatment of this case, high attention was paid to the important influence of children's mental factors among causes of difficult extubation, which provided a reference for clinical treatment of extubation in children with tracheal tube after tracheotomy.
2016年11月4日，一名1岁3个月大的男性患者，面部及颈部烫伤并伴有严重口咽烫伤，于受伤后1小时被送入广州红十字会医院。患儿受伤后2小时出现上呼吸道梗阻，遂立即行气管切开及插管以建立人工气道，并进行抗感染、补液、换药等对症治疗。受伤后第10天，患儿在拔管前堵管时出现呼吸困难，难以拔管，继续进行呼吸机辅助通气及加强抗感染等对症治疗。受伤后第17天，调整拔管方案。拔管前30分钟，肌肉注射苯巴比妥镇静，使用阿托品减少气道分泌物，之后拔管成功。经过21天治疗，患儿治愈出院。在该病例的治疗中，高度重视儿童心理因素在拔管困难原因中的重要影响，为气管切开术后小儿气管导管拔管的临床治疗提供了参考。
