鼻脊造成經鼻氣管插管時氣囊破裂：病例報告

Cuff Damage Caused by A Nasal Spur during Nasotracheal Intubation: A Case Report

鼻中膈彎曲導致氣管內管的氣囊損傷的情形很少發生，氣囊破損造成造成氣囊無法充飽，以至血液，口水，胃內容物會進入下呼吸道。無法充飽的氣囊同時也造成呼吸管路的漏氣，會導致換氣不足，肺塌限，甚至低血氧。我們報告一個病例，在麻醉誘導後，經鼻插管時，發生氣囊破裂的情形；在更換氣管內管後，仍然重複發生氣囊破損的事件。經術後鼻鏡及三維電腦斷層重組影像，確定診斷為嚴重鼻中膈彎曲導致氣管內管通過鼻道時，發生氣囊破裂的情形。並探討在經鼻插氣管內管前，評估呼吸道的暢通度的方法，以減少氣囊破裂的風險。醫師應該隨時警覺插鼻管時之有機會面到這種特殊的併發症以及處置方式。

Damage to the cuff of an endotracheal tube caused by a nasal spur is rare, but may cause the cuff to deflate and lead to aspiration of blood, saliva, or gastric contents and to gas leakage from the breathing circuit, causing hypoventilation, atelectasis, and hypoxia. We here report a case of nasotracheal tube cuff tear caused by a large nasal septal spur during intubation. The diagnosis was confirmed by postoperative three-dimensional computed tomography and rhinoscopy. We also discuss methods for inspecting the nasal passage to reduce possible complications during nasotracheal intubation. Doctors performing nasotracheal intubation should be aware of this complication and its management.