■气管损伤是一种罕见但潜在严重的气管插管急性并发症。文献中很少报道与凝血异常相关的气管损伤病例。我们介绍了一例罕见的甲状腺切除术后气管损伤并伴有凝血异常的患者。
■一名58岁女性,有乳腺癌术后化疗史,胃息肉,多发性结肠息肉,食管乳头状腺瘤,甲状腺切除术后第3天10ml咯血后,甲状腺腺瘤出现呼吸困难;她被送进重症监护病房,并接受了气管插管以维持气道。随后的支气管镜检查显示,在气管阻塞管腔的部分,距隆突5厘米处的结节性红色肿瘤。表面有少量新鲜出血。气管损伤被认为是初步诊断。纤维支气管镜引导气管插管有助于防止肿瘤破裂,插管适当充气以阻止出血,同时阻塞气管的下部。对宫颈血肿进行了紧急手术疏散,以管理术后出血。尽管频繁输血,患者仍表现出持续性全血细胞减少症。实验室检查结果提示凝血指标异常,贫血,和肝功能障碍。经过多学科小组讨论,垂体后叶素用于止血,氨甲环酸用于加强止血治疗,开始营养支持和抗感染治疗。进行气管内套囊充气以压缩出血部位。气管损伤后9天观察到皮下血肿完全消退;支气管镜检查显示气道血肿中残留瘀斑,没有阻塞的迹象。
■使用气管内插管对限于粘膜或粘膜下层的气管损伤进行保守治疗,而没有大量的活动性出血被认为是一种实用有效的方法。通过适当的临床怀疑确保了成功的管理,早期多学科团队讨论,及时诊断和干预。
UNASSIGNED: Tracheal injury is a rare but potentially serious acute complication of endotracheal intubation. Very few cases of tracheal injury associated with coagulation abnormalities have been reported in the literature. We present a rare
case of a patient presenting with tracheal injury in combination with coagulation abnormalities following thyroidectomy.
UNASSIGNED: A 58-year-old woman with a history of postoperative chemotherapy for breast cancer, gastric polyps, multiple colonic polyps, esophageal papillary adenomas, and thyroid adenomas presented with dyspnea following 10 ml hemoptysis on the third day after thyroidectomy; she was admitted to the intensive care unit and underwent tracheal intubation for maintaining the airway. Subsequent bronchoscopy revealed a nodular red neoplasm 5-cm from the carina in the trachea obstructing part of the lumen, with a small amount of fresh hemorrhage on the surface. Tracheal injury was considered the preliminary diagnosis. Fiberoptic bronchoscope guided tracheal intubation helped prevent rupture of the tumor, and the cannula was properly inflated to arrest the bleeding while blocking the lower part of the trachea. An emergency surgical evacuation of the cervical hematoma was performed for managing postoperative bleeding. The patient demonstrated persistent pancytopenia despite frequent transfusions. Laboratory examination results revealed abnormal coagulation parameters, anemia, and hepatic dysfunction. Following a multidisciplinary team discussion, pituitrin for hemostasis, tranexamic acid for strengthening hemostasis treatment, and nutritional support and anti-infection treatment were initiated. Endotracheal tube cuff inflation was performed to compress the bleeding site. Complete resolution of the subcutaneous hematoma was observed nine days after the tracheal injury; bronchoscopy revealed residual ecchymosis in the airway hematoma with no evidence of obstruction.
UNASSIGNED: Conservative management of tracheal injury limited to the mucosa or submucosa without significant amount of active bleeding using endotracheal intubation is considered a practical and effective approach. Successful management was ensured by appropriate clinical suspicion, early multidisciplinary team discussion, and prompt diagnosis and interventions.