因气道分叉处异物取出而行气管切开术的患儿。
Child requiring tracheostomy for removal of an airway foreign body at the tracheal bifurcation.
机构信息
Department of Pediatrics, Division of Pediatric Emergency and Critical Care, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
Otolaryngology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
出版信息
BMJ Case Rep. 2022 Jul 14;15(7):e250399. doi: 10.1136/bcr-2022-250399.
Airway foreign bodies are typically removed orally using a rigid bronchoscope. We present a rare case of a foreign body at the tracheal bifurcation that required removal via tracheostomy. A child turned pale while eating nuts and was suspected to have choked on a foreign body. CT revealed a foreign body at the tracheal bifurcation. As his respiratory condition was unstable, tracheal intubation and removal were attempted using a rigid bronchoscope. Tracheal obstruction during oral removal resulted in respiratory failure and bradycardia. Following emergency tracheostomy, the foreign body was removed via the tracheal stoma after his respiratory condition stabilised. The patient was discharged 21 days later without neurological sequelae. To avoid hypoxaemia during airway foreign body removal, as in this case, assessing the size of the upper airway and foreign body is necessary. Tracheostomy and foreign body removal through the tracheal opening should be considered proactively.
气道异物通常通过硬质支气管镜经口取出。我们报告一例罕见的位于气管分叉处的异物，需要通过气管切开术取出。一名儿童在食用坚果时面色苍白，疑似被异物卡住。CT 显示气管分叉处有一异物。由于他的呼吸状况不稳定，尝试使用硬质支气管镜进行气管插管和取出异物。在经口取出过程中发生气管阻塞，导致呼吸衰竭和心动过缓。在呼吸状况稳定后，行紧急气管切开术，通过气管造口取出异物。患者在 21 天后出院，无神经后遗症。为避免本例中气道异物取出过程中的低氧血症，有必要评估上气道和异物的大小。应积极考虑行气管切开术并通过气管切开处取出异物。
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