产后外伤性喉气管撕裂的麻醉处理：病例报告
Anesthetic Management of Traumatic Laryngotracheal Laceration in a Postpartum Patient: A Case Report.
摘要(中文译文)
创伤性喉气管裂伤罕见但可立即危及生命，需要快速、个体化的气道管理。麻醉医师面临双重挑战：既要确保受损气道安全，又要避免部分撕裂进展为完全横断。我们报告一例35岁女性患者，产后28天，因自伤性颈部前部穿透伤就诊于急诊科。入院时，患者有声嘶、中度呼吸窘迫和广泛皮下气肿。颈部计算机断层扫描显示甲状软骨水平喉前壁5 cm全层缺损，伴双侧气管旁气囊，无明显远端气道中断证据。鉴于气道可能迅速恶化，计划急诊手术修复。气道管理在保留自主呼吸的情况下进行，使用静脉芬太尼和递增吸入七氟烷。视频喉镜（VL）使声门得以显露，首次尝试即使用弹性探条和7.0 mm带套囊气管导管（ETT）成功完成气管插管。随后使用可弯曲纤维支气管镜（FOB）将导管尖端推进至裂伤远端，并确认气管支气管连续性直至隆突。仅在确定性气道控制建立后，才给予静脉罗库溴铵实施神经肌肉阻滞，随后转为控制通气。确定性手术修复顺利完成。患者带管转入重症监护病房，术后第2天（POD 2）经气道评估后成功拔管，POD 6出院，仅遗留轻微发声障碍。本病例表明，在部分喉部断裂的特定病例中，可在自主呼吸下实施控制性经口气管插管并经支气管镜确认，安全可行；这与经伤口插管不同，后者通常仅用于完全横断。
Abstract
Traumatic laryngotracheal lacerations are rare but immediately life-threatening injuries that require rapid, individualized airway management. The anesthesiologist faces the dual challenge of securing a compromised airway while avoiding progression of a partial tear to a complete transection. We report the case of a 35-year-old woman, 28 days postpartum, who presented to the emergency department after a self-inflicted penetrating anterior neck injury. On arrival, she had hoarseness, moderate respiratory distress, and extensive subcutaneous emphysema. Computed tomography of the neck demonstrated a 5-cm full-thickness defect in the anterior laryngeal wall at the level of the thyroid cartilage, with bilateral paratracheal air pockets and no clear evidence of distal airway disruption. Given the risk of rapid airway deterioration, urgent surgical repair was planned. Airway management was performed while preserving spontaneous ventilation using intravenous fentanyl and incremental inhalational sevoflurane. Videolaryngoscopy (VL) enabled visualization of the glottis, and tracheal intubation was successfully achieved on the first attempt using a gum-elastic bougie and a 7.0-mm cuffed endotracheal tube (ETT). Flexible fiberoptic bronchoscopy (FOB) was then used to advance the tube tip distal to the laceration and confirm tracheobronchial continuity up to the carina. Neuromuscular blockade with intravenous rocuronium was administered only after definitive airway control had been secured, followed by transition to controlled ventilation. Definitive surgical repair proceeded uneventfully. The patient was transferred intubated to the intensive care unit, successfully extubated on postoperative day (POD) 2 following airway assessment, and discharged on POD 6 with minimal residual dysphonia. This case demonstrates that controlled orotracheal intubation under spontaneous ventilation, with bronchoscopic confirmation, can be safely performed in selected cases of partial laryngeal disruption, in contrast to wound intubation, which is typically reserved for complete transections.
如何引用
AMA
Nistha S Malik, Priyanka Mallya, Abhishek Singh. Anesthetic Management of Traumatic Laryngotracheal Laceration in a Postpartum Patient: A Case Report.. Cureus. 2026; doi:10.7759/cureus.109371.
APA
Nistha S Malik, Priyanka Mallya, Abhishek Singh (2026). Anesthetic Management of Traumatic Laryngotracheal Laceration in a Postpartum Patient: A Case Report.. Cureus. https://doi.org/10.7759/cureus.109371
GB/T 7714
Nistha S Malik, Priyanka Mallya, Abhishek Singh. Anesthetic Management of Traumatic Laryngotracheal Laceration in a Postpartum Patient: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.109371.
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