■鼻胃管综合征(NGTS)是一种罕见但可能危及生命的并发症。同时接受气管切开术和留置鼻胃管(NGT)的患者并不少见,然而,由于NGTS,气管造口术拔管困难尚未报道。
方法:一名65岁女性因颈椎狭窄和颈脊髓损伤后跌倒住院。外科医生计划做颈部手术,但由于麻醉诱导期间的紧急气道,意外的气管切开术不得不进行.然后,她患有急性呼吸窘迫综合征,并接受了一系列治疗,包括留置NGT。大约两周后,计划气管造口术拔管。气管造口术-导管闭塞试验后,然而,她经历了严重的吸气困难。严重的声门上肿胀被发现,声门的开口完全被肿胀的组织覆盖。气管造口术后三周,气道通畅性检查再次失败,NGT被删除。最后,气管切开后5周成功拔除气管切开管.
■该患者由于上呼吸道阻塞而出现了困难的气管切开拔管,NGTS被认为是主要原因。尽管在这种情况下没有发生声带麻痹和环状软骨后溃疡,我们认为,严重的指齿周围肿胀也可能是NGTS的症状。在这个病人身上,NGT切除后上气道水肿逐渐缓解,2周后,人工气道也被移除。因此,去除NGT是处理NGTS的主要措施。
结论:应注意NGTS对长期气管切开和NGT插入的患者拔管的影响。
UNASSIGNED: Nasogastric tube syndrome (NGTS) is a rare but potentially life-threatening complication. Patients receiving both tracheostomy and indwelling nasogastric tube (NGT) are not uncommon, however difficult tracheostomy
decannulation due to NGTS has not been reported.
METHODS: A 65-year-old woman was hospitalized with cervical spine stenosis and cervical spinal cord injury after a fall. The surgeon planned neck surgery, but unanticipated tracheotomy had to perform due to emergency airway during anesthesia induction. She then suffered from acute respiratory distress syndrome and underwent a series of treatments including indwelling NGT. About 2 weeks later, tracheostomy
decannulation was planned. Following tracheostomy-tube-occlusion test, however, she experienced severe inspiratory difficulty. Severe supraglottic swelling was found, and the opening of glottis was completely covered by swollen tissue. Three weeks post-tracheostomy, the airway patency test failed again, and NGT was removed. Finally, the tracheostomy tube was successfully removed at 5 weeks after tracheotomy.
UNASSIGNED: This patient developed difficult tracheostomy
decannulation due to upper airway obstruction, and NGTS was considered as the main cause. Although vocal cord paralysis and post-cricoid ulcer did not occur in this
case, we suggest that severe periglottic swelling may also be a symptom of NGTS. In this patient, upper airway edema gradually relieved after NGT removal, and the artificial airway was also removed 2 weeks later. Therefore, removal of NGT is the primary measure to deal with NGTS.
CONCLUSIONS: Attention should be paid to the effect of NGTS on
decannulation in patients receiving long-term tracheotomy and NGT insertion.