Successful Repair of Complete Traumatic Tracheobronchial Disruption with Extra-corporeal Membrane Oxygenation Support

在葉克膜支持下創傷性氣管完全分離的成功修補：病例報告

梁嘉儀(Ka-I Leong) ； 黃培銘(Pei-Ming Huang) ； 柯文哲(Wen-Je Ko) ； 李元麒(Yung-Chie Lee)

《胸腔醫學》 25卷5期 (2010/10) Pp. 263-267

https://doi.org/10.29806/TM.201010.0006

摘要

胸部挫傷而造成的氣管完全分離的病例是不常見但致死率高，大約80%以上的病人在事發現場已死亡。因此，救援過程中心肺的維持與足夠氧氣的提供對此類病人的生存率是十分重要。本病例是一個47歲男性，在工作時被重型機器壓倒。於急診處，病人呼吸急促，右側大量氣胸並置入胸管。支氣管鏡顯示右側主氣管斷裂故進行氣管插管並進行單肺呼吸。由於病人血氧分壓沒能有效維持，在手術前放置了葉克膜以提供足夠的氧氣及穩定心肺的功能。病人利用右側開胸手術以進行氣管縫合，術後病人復原情況理想，術後兩天移除葉克膜。現病人在門診持續追蹤，沒有明顯的呼吸困難，肺功能也在正常值內。葉克膜多應用在創傷性肺部，以減少因正壓呼吸而引起的傷害以及兒童氣管狹窄重建手術，不管在術中或術後都可提供全身組織的氧氣及心肺的支持。

關鍵字

支氣管分離 ； 葉克膜

並列摘要

Complete tracheo-bronchial disruption following blunt chest trauma is rare. The prognosis is poor, with almost 80% of patients dying at the scene of injury. Successful treatment requires a high level of alertness and early surgical repair. At the same time, providing adequate oxygenation and maintaining stable hemodynamics are frequently difficult in these types of airway injuries. We reported the case of a 47-year-old man with an anterior chest wall crush injury who was given extra-corporeal membrane oxygenation (ECMO) support in the management of a completely transected right main bronchus and ruptured trachea following blunt chest trauma. Post-operative bronchoscopic examination showed good healing with no stricture, and the patient was asymptomatic 18 months after surgery. ECMO is used for oxygen supplementation during reconstruction in many traumatic lung injury and pediatric tracheal stenosis patients. Good survival and outcomes have been noted in the medical literature. Systemic tissue oxygenation and cardio-pulmonary support can be maintained during the peri-and post-operative period via the extra-corporeal circuit to minimize lung barotrauma from prolonged high positive pressure. In our case, ECMO was successfully used in a patient with bronchial transection to provide adequate oxygen supplementation and tissue perfusion before and after surgery.

並列關鍵字

tracheo-bronchial disruption ； extra-corporeal membrane oxygenation