闭合性气管离断伤麻醉处理1例  

Anesthetic management of a patient with closed tracheal transection

作　　者：龙送开 黄改军 郭渊源 黄助军 易虎 LONG Songkai;HUANG Gaijun;GUO Yuanyuan;HUANG Zhujun;YI Hu(Department of Anesthesiology,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412007,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院麻醉科,湖南株洲412007

出　　处：《中南大学学报(医学版)》2024年第9期1538-1542,共5页Journal of Central South University :Medical Science

摘　　要：闭合性气管损伤是一种罕见的临床急症,且极易漏诊和误诊,处置不当可危及患者生命。本文报告1例闭合性气管离断伤患者行气道重建术的麻醉处理过程。患者为33岁男性,车祸后头颈部疼痛、气促4h,气道CT三维重建检查提示气管上段断裂,急诊在全身麻醉下行颈部探查+气管端端吻合术。本病例麻醉处理采用保留自主呼吸、浅镇静和镇痛的方式,经探查气管断端情况后再行纤维支气管镜引导下经鼻气管插管,最终成功地配合外科医师重建了气道。术后患者恢复良好出院,随访1年无不适。对于闭合性气管外伤患者,麻醉医师要高度重视,制订麻醉管理预案,保证有效通气,切忌盲目气管插管。Closed tracheal injury is a rare clinical emergency that is prone to misdiagnosis and missed diagnosis.Improper management can be life-threatening.This report describes the anesthetic management of a patient with closed tracheal transection undergoing airway reconstruction surgery.The patient,a 33-year-old male,presented with head and neck pain and dyspnea 4 hours after a car accident.CT with 3-dimensional airway reconstruction revealed upper tracheal transection.Emergency cervical exploration and end-to-end tracheal anastomosis were performed under general anesthesia.The anesthetic approach included preserving spontaneous respiration with mild sedation and analgesia,followed by fiberoptic bronchoscope-guided nasal tracheal intubation after confirming the transection site.The airway was successfully reconstructed in cooperation with the surgical team.The patient recovered well postoperatively and was discharged without complications.One-year follow-up showed no adverse outcomes.For patients with closed tracheal trauma,anesthesiologists must remain vigilant develop a comprehensive anesthetic plan,ensure effective ventilation,and avoid blind tracheal intubation.

关 键 词：闭合性损伤 气管离断 气管重建 困难气道 气道管理 

分 类 号：R614[医药卫生—麻醉学]