背景:气管动脉瘘是气管造口术后最具破坏性的并发症,和它的死亡率,如果没有明确的治疗,接近100%。总的来说,结合床边应急管理,也就是说,气管切开套管套过度膨胀,和明确的治疗,如手术或血管内干预是必要的,以防止不良的结果。患有神经肌肉疾病如肌萎缩侧索硬化症的患者由于长期机械通气和肌肉无力而易患气管动脉瘘。
方法:我们描述了一例39岁的日本肌萎缩侧索硬化症患者的气管动脉瘘,并进行了长期呼吸机管理。由于前哨出血后大量出血,该患者在临床上被诊断为气管动脉瘘。单纯气管切开套管套囊过度膨胀控制大出血,没有明确的治疗。
结论:此病例提示单独气管切开管套囊的过度膨胀起着重要作用,半永久性的,在气管动脉瘘的治疗中,特别是在没有手术或血管内介入的情况下。护理长期机械通气的气管造口术患者的临床医生应意识到气管造口术后可能会发生气管动脉瘘。
BACKGROUND: Tracheoarterial fistula is the most devastating complication after tracheostomy, and its mortality, without definitive treatment, approaches 100%. In general, the combination of bedside emergency management, that is, overinflation of the tracheostomy tube cuff, and definitive treatment such as surgical or endovascular intervention is necessary to prevent the poor outcome. Patients with neuromuscular diseases such as amyotrophic lateral sclerosis are susceptible to tracheoarterial fistula because of long-term mechanical ventilation and muscle weakness.
METHODS: We describe a case of tracheoarterial fistula in a Japanese 39-year-old patient with amyotrophic lateral sclerosis with long-term ventilator management. The patient was clinically diagnosed with a tracheoarterial fistula because of massive bleeding following sentinel hemorrhage. The massive hemorrhage was controlled by overinflation of the tracheostomy tube cuff alone, without definitive treatment.
CONCLUSIONS: This case suggests overinflation of the tracheostomy tube cuff alone plays an important role, semi-permanently, in the management of tracheoarterial fistula, especially in cases where surgical or endovascular intervention is not indicated. Clinicians taking care of patients with tracheostomy undergoing long-term mechanical ventilation should be aware that tracheoarterial fistula might occur following tracheostomy.