Tracheal-Innominate Artery Fistula due to Tracheostomy
Tracheal-Innominate Artery Fistula due to Tracheostomy
复制标题
气管造口术引起的气管无名动脉瘘
DOI：
10.1378/chest.68.5.678
复制
发表时间：
1975
期刊：
影响因子：
9.6
通讯作者：
W. H. Anderson
中科院分区：
文献类型：
--
作者：
E. Lane;G. Temes;W. H. Anderson
本文介绍了六例气管切开术后晚期大量出血的病例，临床诊断为气管无名动脉瘘。该实体从原因、因素如气管切开插管放置在第三气管环下方、使用前角90度的移动不合适插管、使用金属管上的高压袖带而不是塑料管上的大容量低压袖带以及头部过度伸展等因素来讨论。如果有足够的时间，建议的诊断措施包括纤维支气管镜检查和动脉造影。如果没有，治疗方法包括通过气管造口用手指压迫无名动脉抵靠胸骨，然后立即通过胸骨正中切开术进行手术干预，对无名动脉进行结扎或切除，或两者兼而有之。气管无名动脉瘘的预后很差，但积极的治疗可能会挽救许多患者的生命。
Six cases of massive late bleeding following tracheostomy, diagnosed clinically as tracheal-innominate artery fistula, are presented. This entity is discussed from the point of view of causes, factors such as low placement of the tracheostomy tube below the third tracheal ring, utilization of a mobile ill-fitting tube with an anterior angulation of 90 degrees, use of high-pressure cuffs on metal tubes rather than high-volume low-pressure cuffs on plastic tubes, and hyperextension of the head. Suggested diagnostic measures include fiberoptic bronchoscopy and arteriography if there is enough time. If not, management involves digital compression of the innominate artery against the sternum through the tracheal stoma followed by immediate surgical intervention via median sternotomy, with ligation or resection, or both, of the innominate artery. Prognosis of tracheal-innominate artery fistula is poor, but aggressive management may save many patients.