Hawkins D B, Seltzer D C, Barnett T E, Stoneman G B
West J Med. 1974 Apr;120(4):282-6.
Perforation of the hypopharynx or esophagus is a serious though not often reported complication of endotracheal intubation. Only 12 cases had been reported before the eight which are presented here to emphasize this hazard of intubation. The early symptoms of perforation, which occurred during insertion of the tube, were: subcutaneous emphysema (seven patients), mediastinal emphysema (six), pneumothorax (two), cardiac arrest (one). One patient had no recognized early signs of perforation, but presented with an abscess of the mediastinum six weeks later. The site of perforation, determined by endoscopy in six patients, was the lateral hypopharynx in four, and the vallecula in two. The outcome of the eight perforations was as follows: two patients recovered on conservative management; in two, abscesses of the neck and in one an abscess of the mediastinum developed. All three recovered after drainage of the abscesses. Three patients died. Two outstanding characteristics of these eight cases were that in all of them intubation was attempted by physicians relatively inexperienced in the technique, and in all but one it was done in emergency. Since the use of intubation in emergency situations is increasing, all physicians in training should receive formal instruction in technique.
下咽或食管穿孔是气管插管的一种严重但并不常被报道的并发症。在本文所介绍的8例病例之前，仅有12例相关病例被报道过，在此展示这8例以强调插管的这种风险。穿孔的早期症状出现在插管过程中，包括：皮下气肿（7例患者）、纵隔气肿（6例）、气胸（2例）、心脏骤停（1例）。1例患者在穿孔时未出现可识别的早期症状，但6周后出现纵隔脓肿。6例患者经内镜检查确定穿孔部位，其中4例位于下咽外侧，2例位于会厌谷。8例穿孔的结果如下：2例患者经保守治疗康复；2例出现颈部脓肿，1例出现纵隔脓肿，这3例在脓肿引流后均康复。3例患者死亡。这8例病例的两个显著特点是，所有病例均由插管技术相对不熟练的医生尝试插管，且除1例之外均在紧急情况下进行。由于紧急情况下插管的使用正在增加，所有接受培训的医生都应接受插管技术的正规指导。
