Tracheal closure injury
Introduction
Introduction to tracheal closure injury Closed-juvenile injury (closedinjuryoftrachea) is rare, because there is a mandible and sternum in front of the trachea, and there is a spine protection behind. The upper end of the neck trachea is shallower, and the lower end is deep in the sternum, and the surface is covered with skin and neck muscles. Because of the mobility of the trachea itself, the elasticity of the cartilage ring and the cavity scaffold structure of the cartilage make it less susceptible to trauma. However, if the trachea is contused, it will endanger life, or form a narrowing of the trachea, affecting respiratory function. basic knowledge Sickness ratio: 0.01%-0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: tracheoesophageal fistula
Cause
Causes of tracheal closure injury
Causes
Closed injury of the trachea is rare, and there are three reasons for its damage:
Direct blunt force (30%):
Combating the neck or violent violence hitting the chest. When a direct blunt force hits the neck or a violent violent impact on the chest, the elastic chest squeezes the trachea against the hard cervical vertebra, causing the trachea to tear at the back or the cartilage ring to break.
Head back (20%):
The trachea suffers from direct contusion and strong traction. If the head is reclined when injured, the neck trachea protrudes forward, and the trachea is vulnerable to direct contusion and strong traction, especially when the patient is in a state of terror.
Glottic closure (20%):
The pressure in the chest or trachea rises sharply, causing the trachea to rupture. The glottis is tightly closed, the chest is strongly squeezed, the air pressure in the trachea and the bronchi is obviously increased, and the tracheal rupture is prone to occur. It has been reported that a fierce true crumb-like cough or a spastic cough caused by a foreign body in the throat may also cause tracheal rupture. Endotracheal intubation anesthesia, due to excessive balloon pressure or high pressure oxygen, the pressure inside the trachea rises, can also cause tracheal rupture.
Prevention
Tracheal closed injury prevention
The prevention of this disease is mainly early detection, early diagnosis, early treatment of primary diseases, the possibility of airway stenosis should be considered for the lesions occurring in the trachea and bronchus, and the occurrence of airway stenosis should be prevented in advance. At the time of examination, tracheal lipiodol imaging is valuable for the diagnosis of tracheal stenosis and stenosis, but it is worth noting the risk of obstruction of tracheal obstruction. Not used unless otherwise clarified by other inspection methods.
In addition, because the neck is short, the tracheal lumen is small, the cartilage is soft, and the anatomical marks such as thyroid cartilage and ring cartilage are difficult to find. It is often considered that the risk of surgery in children is large, the complications are many, and the postoperative care is difficult, always in the condition. After the aggravation, it is necessary to consider the operation when it is necessary, artificially increasing the difficulty of surgery. For patients who need surgery, if the blood oxygen level is less than 80%, it is advisable to perform the operation as soon as possible. Before the operation, the tracheal intubation should be performed conditionally. The tracheal intubation is short, the secondary injury is small, and the breathing difficulty can be relieved in time. Trachea and pulmonary secretions, to avoid suffocation during surgery, reduce complications such as pneumothorax and mediastinal emphysema. After tracheal intubation, emergency surgery becomes a common operation, which is conducive to finding trachea and intraoperative operations, improving the safety of surgery and facilitating rescue treatment.
Complication
Complications of tracheal closure injury Complications of tracheoesophageal fistula
Tracheal esophageal fistula and mediastinal inflammation of the tracheal injury combined with esophageal tears, can be complicated by tracheoesophageal fistula, severe cases can cause mediastinal inflammation, the consequences are serious.
Symptom
Tracheal occlusive injury symptoms Common symptoms Respiratory tract obstruction, difficulty in breathing, subcutaneous emphysema, asphyxia, hemoptysis, crush injury
Similar to blunt laryngeal contusion, but with primary and secondary.
1. Cough and hemoptysis due to tearing of mucous membrane or cartilage ring, blood flowing into the trachea, causing irritating cough, severe injury, paroxysmal cough with bloody foam, sometimes no blood in the mouth and throat, but bronchoscopy Blood can be seen in the trachea.
2. Subcutaneous emphysema is an important sign. Emphysema can be limited, non-progressive, or develop rapidly after a few hours. The neck emphysema can expand up and down, and severe cases can affect the whole body.
3. Dyspnea and severe cyanotic rupture, in addition to complicated subcutaneous emphysema, there are still mediastinal emphysema, tension pneumothorax, manifested as dyspnea, hypoxia, cyanosis, if the tracheal ring avulsion and separation, airway obstruction Heavy, suffocation can occur.
4. Pain and tenderness in the tracheal wound.
Examine
Examination of tracheal closure injury
1. Bronchoscopy: Bronchoscopy can be performed when the patient's condition permits, which is helpful for identifying the location and extent of the injury.
2. X-ray film: Before the onset of clinical symptoms, X-ray examination can find mild emphysema, and should continue to observe its development.
3. CT scan: can show the damage of the tracheal cartilage ring.
Diagnosis
Diagnosis and identification of tracheal closed injury
Diagnostic criteria
1. History: A history of neck contusion or chest crush injury.
2. Clinical manifestations: If there is pain and tenderness in the tracheal area, cough foamy blood stasis, subcutaneous emphysema, difficulty breathing, it should be highly suspected of tracheal contusion.
3. Auxiliary examination and diagnosis.
Differential diagnosis
Patients with tracheal and bronchial stenosis can be diagnosed by clinical symptoms and X-ray examination or endoscopy. The main need for identification is the differential diagnosis of the primary disease, which is of great significance for the correct treatment of this disease. From this point of view, the treatment of tracheal stents is a palliative method in cases where the primary disease is not cured. The primary diseases of trachea and bronchoconstriction are as follows:
1. Scar lesions caused by tuberculosis, trauma, etc.
2. Scarred tracheobronchial stenosis caused by tracheotomy.
3. Tracheobronchial stenosis caused by malignant tumors.
