- 期刊
Insidious Tracheobronchial Obstruction in Ventilated Patient due to Silent Blood Aspiration: A Case Report
在輔助呼吸下因潛發性血吸入導致氣管支氣管內阻塞：病例報告
摘要
本病例乃一腦血管疾病併發上消化道出血的病人，在經緊急置入氣管內管後以呼吸器幫助呼吸。後來發現有咽喉部出血。經初步處理咽喉出血後在換氣時漸漸發現有呼吸道壓力上升，換氣困難及吵雜之呼吸現象。因吸痰導管能在與阻力下順利通過氣管內管，故初部排除氣管內管阻塞並以治療支氣管痙孿方法處理。後因需接受氣管切開術，在換除氣管內管時，發現在氣管內管前端側孔處附黏有一約十六合分之長條狀血塊。才知是血塊引致的氣管支氣管內阻塞。因在緊急置入氣管內管時無血吸入表徵，所以認定血塊是因潛發性血吸入所致。本文討論此一不尋常的病例及其發生的可能原因及預防建議。
關鍵字
無資料並列摘要
We present a case of pharyngeal and upper GI bleeding for tracheostomy who developed difficulty with endotracheal tube (ETT) ventilation due to a tracheobronchial plugging with blood. The onset of obstruction was insidious and the patient was initially treated as bronchospasm until the original endotracheal tube was replaced by a tracheostomy endotracheal tube. Extubation of the original endotracheal tube revealed a large cylindrical blood plug adhering to the Murphy's eye of the ETT. The plug was suspected to be due to silent bloody aspiration from the pharynx. The presence of a tracheobronchial blood plug should be suspected in patients with pharyngeal bleeding and ventilation difficulties.
延伸閱讀
- 林淑珍、吳昭玲、洪欣、郭耀文、吳惠東（2021）。【論文摘要】氣管支氣管巨大症導致氣切管漏氣之呼吸照護。呼吸治療，20(2)，105-106。https://doi.org/10.6269/JRT.202107_20(2).0036
- Lin, H. C., Shih, S. J., Chao, W. C., Liu, P. C., Hsu, J. Y., & Wu, C. L. (2008). 使用呼吸器且接受氣管切開術的病人其發生氣切傷口感染的危險因子之探討. 內科學誌, 19(6), 508-515. https://doi.org/10.6314/JIMT.2008.19(6).08
- Teng, C. W., Chen, C. H., Liao, W. C., Tu, C. Y., Shih, C. M., & Hsu, W. H. (2012). 以慢性呼吸困難來表現的氣管許旺細胞瘤：病例報告. 胸腔醫學, 27(3), 181-186. https://doi.org/10.29806/TM.201206.0007
- Kuo, H. Y., Lu, C. H., Shen, Y. S., Lee, S. H., Ho, S. T., Wong, C. S., & Liaw, W. J. (2004). 塵肺症病患於插管抽吸後併發致命性咳血之病例報告. Acta Anaesthesiologica Taiwanica, 42(2), 107-110. https://www.airitilibrary.com/Article/Detail?DocID=02541319-200406-42-2-107-110-a
- Chiu, L. C., Su, I. H., Kao, K. C., Liu, C. Y., Yang, C. T., & Huang, C. D. (2012). 於慢性阻塞性肺疾病併發急性呼吸衰竭病人意外發現支氣管軟化症：一個病例報告. 胸腔醫學, 27(6), 349-356. https://doi.org/10.29806/TM.201212.0004