氣切造口肉芽組織引發急性氣道阻塞之病例報告

Acute Airway Obstruction Associated with Granulation Tissue of Tracheostoma - A Case Report

我們報告一位85歲腦水腫患者接受腦室腹膜引流術，因術中放置氣管內管刮落氣切造口的肉芽組織，及術後加護病房抽痰將該肉芽組織吸入氣管內管中，衍生術後急性呼吸道阻塞及壓力性氣胸，期間患者曾因缺氧造成心臟停止，利用支氣管內視鏡發現一肉芽組織阻塞氣管內管，經緊急更換氣管內管及置放胸管後，解除危機，病患於一週後出院且無後遺症。

We report an 85-year-old tracheostomized male patient who underwent ventriculoperitoneal shunt because of hydrocephalus. Postoperative acute airway obstruction and tension pneumothorax developed due to the granulation tissue of tracheostoma which scraped off from the tracheostoma in the act of endotracheal intubation for operation and it lay dormant around until it was drawn into the endotracheal tube (ETT) by negative pressure during suction of trachea in intensive care unit. Persistent hypoxemia in consequence of airway obstruction resulted in cardiac arrest and expiratory seal of trachea eventuated in tension pneumothorax. Flexible fiberoptic bronchoscopy performed during resuscitation disclosed that the obstruction was due to granulation tissue which blocked the ETT lumen. Immediate exchange of endotracheal tube and placement of chest tube made the patient tide over this crisis. No sequela resulted from this crisis and the patient was discharged one week later.