气管无名动脉瘘术后并发右侧大面积脑梗死一例

梦泽 宋(承德医学院附属医院，中国)
乐 张(承德医学院附属医院，中国)

摘要

本文报道一例62岁女性高血压合并糖尿病患者，因车祸外伤6小时入院。初诊表现为低血容量性休克（BP 72/56mmHg，SpO₂ 80%）及腹部、背部软组织损伤，经扩容后转入ICU并行气管插管。入院第7天拔管后突发喉梗阻，紧急气管切开。第12天气管切开处突发暗红色动脉性出血，探查证实为局部感染坏死侵蚀头臂干动脉后壁（破口5mm），行纵劈胸骨开胸探查术，以5-0 Prolene线缝合血管破口，并以离断带蒂胸锁乳突肌肌瓣覆盖修补区，同时清创坏死气管环（第3-5软骨环）并重建气道。术后第1天患者突发意识丧失，CT示右侧大脑半球大面积梗死，急诊去骨瓣减压后仍持续昏迷，继发神经源性休克、室性心律失常及癫痫，最终家属放弃治疗出院。

关键词

气管无名动脉瘘；气管插管；无名动脉；缺血性脑梗死

参考

Khanafer A , Hellstern V , Meiner H ,et al.Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft[J].CVIR Endovascular, 2021, 4(1).DOI:10.1186/s42155-021-00216-8

Black M D , Shamji F M , Todd T R J .Trachea-innominate artery fistula and concomitant critical cerebrovascular disease[J].Annals of Thoracic Surgery, 1996, 62(1):286-288.DOI:10.1016/0003-4975(96)00178-6.

O’Malley T J , Jordan A M , Prochno K W ,et al.Evaluation of Endovascular Intervention for Tracheo-Innominate Artery Fistula: A Systematic Review[J].Vascular and Endovascular Surgery, 2021(5):153857442098062.DOI:10.1177/1538574420980625.

张潇文,唐涛,李迪,等.急性前循环大血管闭塞性脑梗死进展速度的影响因素分析[J/OL].首都医科大学学报,1-6[2025-07-22].http://kns.cnki.net/kcms/detail/11.3662.r.20250707.1239.002.html.

中华医学会急诊医学分会，急性缺血性脑卒中侧支循环评估与干预中国急诊专家共识组. 急性缺血性脑卒中侧支循环评估与干预中国急诊专家共识. 中华急诊医学杂志，2022，31(10):1310-1318.

茆铭,苏菁菁.气管切开术后发生气管无名动脉瘘的抢救体会及预防[J].中国医师进修杂志, 2016(9):3.DOI:10.3760/cma.j. jssn.1673-4904.2016.09.009

Klemm E , Nowak A K .Tracheotomy-Related Deaths[J].deutsches arzteblatt international, 2017, 114(16):273.DOI:10.3238/arztebl.2017.0273.

Taechariyakul T , Keller F S , Jahangiri Y .Endovascular Treatment of Tracheoinnominate Artery Fistula: Case Report and Literature Review With Pooled Cohort Analysis[J].Seminars in thoracic and cardiovascular surgery, 2020(1):32.DOI:10.1053/j. semtcvs.2019.08.006.

Yang J H , Choi H Y , Nam H S ,et al.Mechanism of infarction involving ipsilateral carotid and posterior cerebral artery territories.[J].Cerebrovascular Diseases, 2007, 24(5):445-451.DOI:10.1159/000108435.

Sun B , Li X , Liu X ,et al.Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus[J].Cardiovascular Diabetology, 2017, 16(1):111.DOI:10.1186/s12933-017-0592-9.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v9i3.37293