Mahattanasakul Patnarin, Kaewkongka Tonphong, Sriprasart Thitiwat, Kerekhanjanarong Virachai
Department of Otolaryngology, Head and Neck Surgery, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand.
Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):1752-1756. doi: 10.1007/s12070-019-01744-5. Epub 2019 Oct 26.
To study the clinical presentation, management and mechanism of fractured outer metallic tracheostomy tube presenting as tracheobronchial foreign body. A retrospective chart review patients with fracture outer metallic tracheostomy tube. Data regarding the patients' demographic data, diagnosis, clinical presentation, type of tracheostomy tube and site of fracture were analyzed. Total 4 cases of fracture outer metallic tracheostomy tube were found. There were 3 males and 1 female, average age 52.75 years, range 31-76 years. The common presentation were dyspnea, intolerable cough and decreased breath sound in 4(100%), 2(50%) and 2(50%) cases. The most serious presentation was cardiac arrested 1 case. The dislodged tube were retrieved by flexible and rigid bronchoscopy. The most common site of fracture were outer tube at mid shaft 3 cases (75%). All of this site had corrosion. Only 1 case (25%) was fracture at junction between neck plate and tube without corrosion. The average time of usage metallic tracheostomy tube was 24 days, range 3-34 days. Fracture tracheostomy tube is rare and serious medical emergency. The patients, caregivers and physicians should recognition and prompt action. Flexible or rigid bronchoscopy via tracheostoma can successfully removal the dislodge part. The mechanism of fracture may come from several factors. The defective manufacturer, stagnation of alkaline bronchial secretion, recurrence process of removal, cleaning and boiling of the tube can cause mechanical stress and degradation of passive film of the tubes. The patient education regarding the maintenance and regular checked up can possibly extinguish this complication.
研究作为气管支气管异物的金属气管切开套管外管骨折的临床表现、处理方法及机制。对金属气管切开套管外管骨折患者进行回顾性病历审查。分析患者的人口统计学数据、诊断、临床表现、气管切开套管类型及骨折部位等数据。共发现4例金属气管切开套管外管骨折病例。其中男性3例，女性1例，平均年龄52.75岁，年龄范围31 - 76岁。常见表现为呼吸困难，4例（100%）出现难以忍受的咳嗽，2例（50%）呼吸音减弱。最严重的表现为1例心脏骤停。通过可弯曲支气管镜和硬质支气管镜取出脱落的套管。最常见的骨折部位是外管中轴处，共3例（75%）。所有这些部位均有腐蚀。仅1例（25%）是颈板与套管连接处骨折，无腐蚀。金属气管切开套管的平均使用时间为24天，范围3 - 34天。气管切开套管骨折是罕见且严重的医疗紧急情况。患者、护理人员和医生应予以识别并迅速采取行动。经气管造口插入可弯曲或硬质支气管镜可成功取出脱落部分。骨折机制可能源于多种因素。制造商缺陷、碱性支气管分泌物停滞、套管取出、清洁和煮沸的反复过程可导致机械应力及套管钝化膜降解。对患者进行维护及定期检查的教育可能会消除这种并发症。
