Clinical Experiences in the Management of Upper Airway Injury

上呼吸道損傷之臨床處理經驗

鄭哲智(Che-Chih Cheng) ； 許晉杰(Chin-Chieh Hsu) ； 陳仁智(Jen-Chih Chen)

《胸腔醫學》 33卷2期 (2018/04) Pp. 63-69

摘要

Airway trauma, also known as tracheobronchial injury, is a cause of immediate death after an accident. For this report, we collected the medical records of 4 patients with upper airway injuries: 1. a patient with blunt chest trauma with tracheal laceration due to a traffic accident; 2. a patient with severance of the larynx by due to a knife wound; 3. a patient with a penetrating injury to the neck with partial transection of the trachea by a knife; and 4. a patient with a penetrating injury to the right upper neck by the metal lock of his helmet in a traffic accident. Our management of these patients involved, conservative treatment with a hand-made tracheostomy tube (a modified endotracheal tube) in patient 1 and surgical repair with absorbable sutures interruptedly in the others. Patient 1 was weaned from the ventilator after 34 days, patient 2 after 8 days, patient 3 after 2 days, and patient 4 after 1 day. All the patients with upper airway injuries survived after our treatment and there was no further complication.

關鍵字

upper airway injury ； tracheobronchial injury

並列摘要

上呼吸道損傷係創傷後立即死亡的原因之一，且其發生率約佔胸頸創傷患者的0.5-2%。而呼吸道的保護是處理氣道損傷患者的首要步驟，通常是採用氣管內管插管的方式，也建議利用支氣管鏡導引，以越過病灶處來進行插管。我們收集了四位氣道損傷的患者：1.車禍導致胸部挫傷併氣管撕裂傷；2.水果刀造成的喉部切割傷；3.美工刀造成的頸部穿刺傷及部分氣管截斷；4.車禍中遭安全帽扣環拉扯造成的上頸部穿刺傷。我們的臨床處理方式如下：個案1採保守治療合併使用自製的加長型氣切管(改造之氣管內管)；其餘三個個案皆採用可吸收線來進行氣道損傷的修補。四個個案脫離呼吸機的時間依序分別為34天、8天、2天及1天。在我們的治療後，全部患者皆順利存活，並且在門診追蹤安排的支氣管鏡、電腦斷層或是肺功能中，皆無發現後續的併發症。

並列關鍵字

氣道損傷 ； 上呼吸道損傷