高頻噴射呼吸器使用於氣管造口探查術之病例報告

High Frequency Jet Ventilation in Exploration of Tracheostomy-- A Case Report

氣管造口探查術雖不罕見，但在臉部有新造重建皮瓣的病人，卻可能因為插管困難而帶來麻煩。本文報告一口腔癌切除後臉部新造重建皮瓣的病人，因氣管造口流血，而必需施行探查術。但由於口腔內大量分泌物及浮腫的口腔黏膜，光纖內視鏡插管失敗。我們改以高頻噴射呼吸器(HFJV)進行換氣（HFJV經一條插入氣管內管的抽痰導管連接）。探查術完成後，氣管內管在抽痰導管引導下重新置回氣管造口內。與HFJV相關的可能併發症及禁忌症均在文中討論。吾人建議，在臉部新造重建皮瓣的病人施行氣管造口探查術麻醉時，如果有完整的準備及監測、及在有經驗的醫師指導下，貫通氣管使用HFJV可作為光纖內視鏡的替代方法。

Exploration of tracheostomy is not uncommon, however, in case a patient with a facial reconstruction flap, trouble may arise because of difficulty in intubation. We hereby report a patient who had a fresh facial reconstruction flap after radical resection of buccal carcinoma, sustained bleeding around the tracheostomy and was scheduled for exploration of tracheostomy. Fiberoptic oral intubation was failed because of profuse secretion and edematous oral mucosa; high frequency jet ventilation (HFJV) was thus applied and made possible with a suction catheter put through the tracheostomy tube. Exploration was performed following withdrawal of the tracheostomy tube. The tracheostomy tube was reinserted under the guidance of the in-place suction tube after uneventful exploration. The probable concomitant complications and contraindications of using HFJV are discussed here. With thorough preparation and careful monitoring, and under the supervision of experienced physicians, transtracheal HFJV can substitute fiberoptic intubation for ventilation in case of exploration of tracheostomy.