[1]傅向军,黄健男,刘华盛,等.外伤性颈动脉破裂急救处理8例[J].新乡医学院学报,2016,33(7):585-588.[doi:10.7683/xxyxyxb.2016.07.009]
　FU Xiang-jun,HUANG Jian-nan,LIU Hua-sheng,et al.Emergency treatment in traumatic carotid rupture：a report of 8 cases[J].Journal of Xinxiang Medical University,2016,33(7):585-588.[doi:10.7683/xxyxyxb.2016.07.009]
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外伤性颈动脉破裂急救处理8例
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
33
期数:
2016年7
页码:
585-588
栏目:
临床研究
出版日期:
2016-07-05

文章信息/Info

Title:
Emergency treatment in traumatic carotid rupture：a report of 8 cases
作者:
傅向军; 黄健男; 刘华盛; 邹苑斌
（广东省第二人民医院耳鼻咽喉-头颈外科，广东　广州　510317）
Author(s):
FU Xiang-jun; HUANG Jian-nan; LIU Hua-sheng; ZOU Yuan-bin
（Department of Otorhinolaryngology-Head and Neck Surgery,Guangdong No.2 Provincial People′s Hospital,Guangzhou 510317,Guangdong Province,China）
关键词:
外伤; 颈动脉破裂; 外科
Keywords:
traumatic; carotid artery rupture; surgery
分类号:
R605.972
DOI:
10.7683/xxyxyxb.2016.07.009
文献标志码:
A
摘要:
目的　探讨外伤性颈动脉破裂外科急救处理措施,总结经验,以提高救治成功率。方法　8例外伤性颈动脉破裂患者在颈部简单压迫止血同时施行了气管插管全身麻醉，其中经喉气管裂开处插管2例，口腔插管6例；颈外动脉及分支结扎2例，颈总动脉紧急结扎1例，颈总动脉纵向破裂采用“次半管缝合”修复5例；8例患者均行术后低位气管切开。围术期加强输血、补液、抗感染等综合治疗。结果　8例患者在全身麻醉下施行了颈总动脉修复和(或)颈外动脉及分支结扎7例，颈总动脉结扎1例。术中失血700～1 000 mL，其中2例术中血压反复波动在休克状态，且与术中出血量不符，疑颈动脉窦减压反射所致，颈总动脉分歧部外膜下局部利多卡因封闭后缓解。随访4个月至5 a，1例颈总动脉紧急结扎者术后偏瘫，于2周后死亡，其余患者均存活，未见脑缺血或栓塞并发症；术区局部感染2例，经术后换药、抗炎处理后痊愈。结论　外伤性颈动脉破裂伤情复杂，病情危重，严重威胁患者生命，其急救处理需要多学科联合施救，早期气管插管、保持呼吸道通畅、及时有效地止血、采用合理方法修复颈动脉损伤、围术期处理及术后并发症的预防均是整体救治的重要环节。
Abstract:
Objective　To discuss the emergency surgical treatment for traumatic carotid artery rupture,and summarize the experience for increasing the successful rate.Methods　Eight cases with traumatic carotid artery rupture were carried neck simple compression hemostasis and imposed endotracheal intubation anesthesia at the same time.In the 8 cases,two cases were given larynx and trachea split intubation;six cases were given oral intubation;two cases were given external carotid artery and branches ligation;one case was given common carotid artery emergency ligation;five cases were given sub-semicanal suture for repairing of longitudinal fracture of common carotid arteries.All the patients were underwent low postoperative tracheotomy.All the patients were given blood transfusion,rehydration,anti-infection and other comprehensive treatment.Results　All cases underwent general anesthesia,in which 7 cases were given common carotid artery repair and(or) part of the external carotid artery and branches ligation;one case was given common carotid artery ligation.The average blood loss intraoperative was 700-1 000 mL.Two patients intraoperative blood pressure fluctuations in the shock state repeatedly,and not in conformity with intraoperative blood loss.It might be caused by carotid sinus depressor reflex,and the blood pressure recovered after topical lidocaine blocking under outer membrane of the divergence of the common carotid artery.The patients were followed-up for 4 months to 5 years.One case with hemiplegia after emergency common carotid arteries ligation,and died after 2 weeks,the other cases were alive and without cerebral ischemic or embolic complications.Two cases appeared surgical local infection,and it recovered after drainage,anti-inflammatory treatment after operation.Conclusion　Traumatic carotid artery rupture injury,which was complicated,in a critical condition,and a serious threat to life,needed a multidisciplinary joint rescue emergency treatment.Early endotracheal intubation to maintain airway patency;timely and effective hemostasis;the use of reasonable methods to repair the carotid artery injury;prevention of postoperative complications are important part of the overall treatment,can not be ignored.

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更新日期/Last Update: 2016-07-05