Tracheoarterial Fistula: An Unusual Complication of Tracheostomy
Tracheoarterial Fistula: An Unusual Complication of Tracheostomy
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气管动脉瘘：气管造口术的一种罕见并发症
DOI：
10.1177/088506669501000203
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发表时间：
1995
影响因子：
3.1
通讯作者：
R. Irwin
中科院分区：
文献类型：
--
作者：
O. Schaefer;R. Irwin
气管动脉瘘是气管切开术中一种罕见但具有破坏性的并发症。它发生的频率约为0.7%，如果不被发现和手术纠正，它是致命的。气管插管造成的粘膜损伤，高袖带压力造成的压力坏死，或插管尖端位置不正确造成的粘膜损伤，导致气管壁侵蚀进入气管前间隙的血管结构。这种并发症引起的出血几乎总是发生在手术后48小时。它通常先于前哨咯血。在此并发症之前或与此并发症相关的体征和症状缺乏，需要高度的临床怀疑指数才能做出诊断。除了出血，其他潜在的线索包括气管造口管的低处、气管造口管的搏动、感染、低血压、营养不良和皮质类固醇的使用。不幸的是，对于气管动脉瘘没有一致的诊断工具。纤维支气管镜检查和血管造影的结果不一。如果没有发现其他原因可以解释气管切开术或周围出血，或疾病远至原发性隆突，则必须将患者送往手术室进行更明确的检查和可能的血管修复。治疗分为急性稳定和支持，保护气道和恢复循环血容量，如果患者存活，则进行最终修复。防止气管造口管损伤气管的措施，如适当的手术技术和适当的气管造口管袖口膨胀，可能会大大避免这种潜在的致命并发症。尽早考虑这一实体可能会挽救受害者的生命。
The tracheoarterial fistula is an unusual but devastating complication of tracheostomy. It occurs with a frequency of approximately 0.7%, and it is uniformly fatal if not recognized and surgically corrected. Mucosal damage from the tracheal cannula, pressure necrosis from high cuff pressure, or mucosal trauma from an improperly positioned cannula tip results in erosion through the tracheal wall into the vascular structures that lie in the pretracheal space. Bleeding from this complication almost always occurs late (> 48 hours postprocedure). It is often preceded by sentinel hemoptysis. A paucity of signs and symptoms that precede or are associated with this complication require a high index of clinical suspicion to make the diagnosis. In addition to bleeding, other potential clues include a low-lying tracheostomy tube, pulsation of the tracheostomy tube, and the presence of infection, hypotension, malnutrition, and corticosteroid use. Unfortunately, there are no consistently useful diagnostic tools for tracheoarterial fistula. Fiberoptic bronchoscopy and angiography have been performed with mixed results. Should no other cause be found to explain the hemorrhage from or around the tracheostomy, or from disease distal to the primary carina, the patient must be taken to the operating room for a more definitive examination and possible vascular repair. Management is divided into acute stabilization and support, with protection of the airway and restoration of circulating blood volume, followed by definitive repair should the patient survive. Measures to prevent tracheal damage by the tracheostomy tube, such as proper surgical technique and proper inflation of the tracheostomy tube cuff, may go a long way to avoid this potentially lethal complication. Early consideration of this entity may be what saves the life of its victim.