使用单药氯胺酮镇静辅助喉镜检查和异物取出治疗急性声门上气道梗阻。

文献信息

中文摘要

一名78岁男性因在家中被食物噎住后出现喘鸣和发声困难就诊。尽管通过非再呼吸面罩吸氧，他仍病情恶化，出现呼吸窘迫，血氧饱和度55%。柔性鼻内镜检查显示会厌和声门之间有食物团块。团队判断在取出前进行呼吸暂停和辅助正压通气具有危险性，而病情恶化和配合有限使清醒技术不可行。单药氯胺酮镇静辅助了视频喉镜检查，临床观察到自主呼吸；使用Magill钳取出了团块，即一片胡萝卜。随后给予罗库溴铵，在其起效前尝试气管插管未成功。随着罗库溴铵起效，喉镜视野改善，并出现大量血性气管液体。吸引后，气管被插管。怀疑负压性肺水肿。他的肺被通气48小时，随后出院回家，无后遗症。该病例说明了分阶段异物取出和随后的气管插管，并准备了神经肌肉阻滞和气道救援。在该患者中，氯胺酮辅助了喉镜检查和异物取出，同时临床观察到自主呼吸。

英文摘要

A 78-year-old man presented with stridor and dysphonia after choking at home. He deteriorated, with respiratory distress and an oxygen saturation of 55% despite oxygen via a non-rebreather mask. Flexible nasendoscopy demonstrated a food bolus between the epiglottis and glottis. The team judged apnoea and assisted positive-pressure ventilation before extraction to be hazardous, while deterioration and limited cooperation made an awake technique impracticable. Sole-agent ketamine sedation facilitated videolaryngoscopy with clinically observed spontaneous breathing; the bolus, a slice of carrot, was removed using Magill forceps. Rocuronium was then administered and an attempt at tracheal intubation prior to its onset was unsuccessful. As rocuronium took effect, the laryngoscopic view improved and copious blood-stained tracheal fluid appeared. Following suction, the trachea was intubated. Negative-pressure pulmonary oedema was suspected. His lungs were ventilated for 48 h, and he was subsequently discharged home without sequelae. The case illustrates staged foreign body removal and subsequent tracheal intubation, with preparation for neuromuscular blockade and airway rescue. In this patient, ketamine facilitated laryngoscopy and foreign body removal while spontaneous breathing was clinically observed.