异物致喉咽损伤的罕见致死性并发症

A. V. Fedin, Федин Андрей Викторович, V. S. Poyarkova, Пояркова Валерия Станиславовна, L. A. Aschina, Ащина Людмила Андреевна, N. Shkurova, Шкурова Наталья Александровна
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摘要

摘要异物致喉咽损伤的致命并发症是一种罕见的现象。在随食物一起摄入的异物中,鱼骨是最常见的。由于边缘锋利,可损伤喉、咽粘膜,从而引起炎症,导致水肿、充血、疼痛加重。此外,异物可引起出血、宫颈痰、皮下肺气肿、食管穿孔、败血症等并发症,可导致患者死亡。然而,由于及时诊断,根据科学文献,这种情况是极其罕见的。由于异物在喉部的可视化是困难的(特别是当定位在梨状窦),喉镜用于诊断。此外,在某些情况下,需要x线检查和计算机断层扫描。本文报告了57岁患者M的临床观察,其死亡原因是罕见的喉咽损伤伴鱼骨并发症。患者入科后,确立临床基本诊断:喉咽损伤合并右侧咽旁脓肿。患者接受了抗菌、输液、抗炎和降压治疗。入院20小时后,患者突然失去意识,心脏骤停,随后死亡。根据临床表现,结论是肺血栓栓塞是可能的死亡原因。尸检显示右颈外静脉损伤,导致血栓性静脉炎,然后是肺动脉血栓栓塞,导致患者死亡。在现有的科学文献中没有发现类似的临床描述。
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A rare lethal complication of larynxopharynx injuries by a foreign body
A lethal complication of laryngopharynx injuries by foreign bodies is a rare phenomenon. Among foreign ­bodies are ingested together with food, fishbones are the most common. They can injure the mucous membrane of the larynx and pharynx due to the sharp edges, thereby causing inflammation, resulting in edema occurs, hyperemia and increased pain. Besides, foreign bodies can provoke complications such as bleeding, cervical phlegmon, subcutaneous emphysema, esophageal perforation, sepsis and others, which can lead to the death of patients. Howe­ver, due to timely diagnosis, according to the scientific literature, such cases are extremely rare. Because the visualization of foreign bodies in the area of the larynx is difficult (especially when localized in the pyriform sinuses), laryngoscopy is used for diagnosis. Moreover, in some cases, X-ray examination and computed tomography are indicated. The paper presents a clinical observation of a 57-year-old patient M., whose cause of death was a rare complication of laryngopharynx injuries with a fishbone. When the patient was admitted to the department, the basic clinical diagnosis was established: laryngopharyngeal injury complicated by right parapharyngeal abscess. The patient underwent antibacterial, infusion, anti-inflammatory and antihypertensive therapy. At 20 hours after hospital admission, the patient had an abrupt loss of consciousness and cardiac arrest, then death. Based on the clinical picture, it was concluded that pulmonary thromboembolism was the probable cause of death. The ­autopsy revealed injury of the right external jugular vein, as a result of which develop thrombophlebitis, and then pulmonary artery thromboembolism, which caused the patient's death. No similar clinical descriptions were found in the available scientific literature.
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