Accidental Esophagotracheal Intubation via Acquired Tracheoesophageal Fistula

食道插管和氣管食道屢管都是嚴重的呼吸道急症，任何一種情況若未及時發現，都足以造成病患死亡。我們報告一位六十七歲接受氣切併長期在呼吸照顧病房倚賴呼吸器維生的女性病患，同時發生這兩種嚴重的呼吸道急症，並且罕見的發生氣管內管錯誤的由食道進入，並意外的穿過氣管食道屢管而進入氣管，造成食道氣管插管。雖然在急診處我們幫此病患做了胸部X光及抽血檢查，並且裝置上各種確認氣管內管位置的儀器；在一切理學，影像學及儀器檢查都確認氣管內管位置正確的同時，我們意外發現病患竟然可以和家屬說話，而病患女兒也驚訝的表示已經許久沒有聽到母親的聲音！在懷疑食道插管及氣管食道屢管的情形下，緊急安排了氣管鏡檢查。在氣管鏡的指引下我們發現氣管內管錯誤的由食道進入，並意外的穿過氣管食道屢管而進入氣管，我們立刻成功為病患重新置放氣管內管，並安排住到胸腔外科病房接受手術治療氣管食道屢管。這個病例告訴我們，急診醫師面對呼吸道急症的病患不能只倚賴各種檢驗儀器和方法來確認氣管內管位置；必須隨時提高警覺，配合完整的身體評估以及理學檢查，才是治療病患的不二法門。

關鍵字

食道插管；氣管食道廔管；氣管插管

並列摘要

A 67 year-old woman who was ventilator dependent experienced desaturation and became comatose after a regular tracheostomy tube change. After emergency oral tracheal intubation and wound closure, she was sent to our emergency department under the impression of acquired tracheoesophageal fistula (TEF). After an emergency bronchoscopy was performed, we indentified that the endotracheal tube (ETT) had been inserted into the esophagus, and had accidentally passed through the TEF with final insertion into the trachea. Under bronchoscopic guidance, orotracheal intubation was performed smoothly. and a TEF repair was also arranged. Three months after this insult, the patient had a stable, relatively good functional airway and esophagus without sequela.

並列關鍵字

esophageal intubation ； orotracheal intubation ； tracheoesophageal fistula

國際替代計量

Accidental Esophagotracheal Intubation via Acquired Tracheoesophageal Fistula

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