Wulf H, Elfeldt R J, Hückstädt A
Klinik für Anästhesiologie und Operative Intensivmedizin, Christian-Albrechts-Universität zu Kiel.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1997 Apr;32(4):258-62. doi: 10.1055/s-2007-995051.
Tracheobronchial ruptures are rare but potentially lifethreatening events. We report on the case of a 34-year-old suicidal unrestrained car driver, who developed subcutaneous and mediastinal emphysema and right-sided haematothorax following blunt thoracic trauma. Fibreoptical inspection of the tracheobronchial system revealed a rupture (approximately 2 cm in length) of the pars membranacea of the trachea ending shortly above the carina. CT-scan confirmed the diagnosis of mediastinal emphysema, tracheal rupture and, in addition, left-sided pulmonary contusion. A repair of the tracheal tear was performed by right-sided thoracotomy using a double-lumen tube. The left-sided double-lumen tube was used postoperatively to achieve respirator ventilation with low pressure on the tracheal lumen and on the suture of the tracheal tear. On the other hand, sufficient airway pressure with PEEP for the left lung showing contusion could be provided, using the endobronchial tube. The postperative course was without complications. The patient was on respiratory support for three days due to his-pulmonary contusion. Following final endoscopic control of the trachea he was discharged from the ICU one week after the trauma. The clinical and radiological signs of tracheobronchial ruptures are discussed (respiratory distress, haemoptysis, cyanosis, localised pain, hoarseness, coughing, dysphagia, stridor, subcutaneous emphysema and pneumothorax, tension pneumothorax, mediastinal emphysema). Fibreoptic bronchoscopy is the present gold standard for confirming the diagnosis. The surgical and anaesthesiological approach to the management of tracheobronchial ruptures is described reviewing the current literature.
气管支气管破裂虽罕见，但可能危及生命。我们报告一例34岁的自杀性未系安全带汽车司机，其在胸部钝性创伤后出现皮下和纵隔气肿以及右侧血胸。对气管支气管系统进行纤维光学检查发现气管膜部有一处破裂（长度约2厘米），在隆突上方不久处终止。CT扫描证实了纵隔气肿、气管破裂的诊断，此外还发现左侧肺挫伤。通过右侧开胸术使用双腔管对气管撕裂进行修复。术后使用左侧双腔管以实现气管腔内和气管撕裂缝合处低压的呼吸机通气。另一方面，使用支气管内导管可为显示挫伤的左肺提供带呼气末正压的足够气道压力。术后过程无并发症。由于肺部挫伤，患者接受了三天的呼吸支持。在对气管进行最终内镜检查后，他在创伤一周后从重症监护病房出院。本文讨论了气管支气管破裂的临床和放射学征象（呼吸窘迫、咯血、发绀、局部疼痛、声音嘶哑、咳嗽、吞咽困难、喘鸣、皮下气肿和气胸、张力性气胸、纵隔气肿）。纤维支气管镜检查是目前确诊的金标准。通过回顾当前文献描述了气管支气管破裂治疗的手术和麻醉方法。
