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男子呼吸不畅突然倒地 医生1分钟紧急开刀救命

2016-12-31 11:05:40   

病情

 10多分钟呼吸困难急升2度

朱学伟让患者立刻住院。“患者说,明天还要参加会议,对于住院有些犹豫。”朱学伟说,像这样以为咽部肿痛是小病,挺一挺吃点药就会好了的片面认识很普遍,是致使急性会厌炎夺取生命的主要原因。男子说要考虑考虑,在急诊大厅转了转。“也就是短短10多分钟的时间,他突然倒在了地上。”虽然前来急诊的人很多,但朱学伟一直在密切关注着这位男患者的动向。“我知道这种病的危害,发病率低,但如果没有及时抢救死亡率很高。”朱学伟见到男子躺在了地上,呼吸已经从急症时的2度呼吸困难急升到4度。呼吸困难分为4度,2度是在平静的时候感到呼吸费力,4度的时候就会有濒死感,就像有人死死地卡住自己的脖子一样,男患者此时出现躁动表现,开始挣扎。

手术

 1分钟紧急开刀 血溅白衣

朱学伟说,当时男子的情况非常危急,抢救时间是以分秒计算的,如果患者窒息时间长,轻则脑部出现不可逆的损伤,重则死亡。急性会厌炎死亡速度甚至比心梗还快。朱学伟和其他医生赶紧将男子抬到抢救室。朱学伟拿起手术刀,找准环甲膜横向切开。

环甲膜是位于甲状软骨下部、环状软骨上部的一块气管壁。此处气管壁由于位于两块软骨之间,因此缝隙较大,经过的血管、神经较少,切开不会造成较大的出血和额外损伤。同时插入呼吸管,建立绕开阻塞物的通气通道,缓解窒息状况,为就医赢得时间。对于病情危急需立即抢救的患者,就需要先行环甲膜切开手术,待呼吸困难缓解后,再做常规气管切开术。

当朱学伟切开男子的环甲膜后,一股鲜血溅到了他的脸上和白色的医生服上。“当时我连口罩都没来得及戴。”朱学伟说,他切开了3厘米左右的创口,用血管钳撑开创口,让空气进入患者的体内,同时将气管套管插进创口处,患者才恢复了呼吸。整个过程只用了1分钟时间,患者转危为安。

一个小时后,朱学伟又为患者进行了气管切开术,插入气管套管。抢救和手术结束后已是凌晨4点多了。

案例

同行曾在饭店用菜刀救人

“韩国电视剧《爱在哈佛》就有这样一个场面。”朱学伟说,女主角是一名医科学生,在街头,她就用钢笔切开了患者的环甲膜,为后续的抢救赢得了时间。“如果我在街头的时候遇到类似的患者,我也可以用钢笔切开患者的环甲膜。”朱学伟说,遇到急性会厌炎等窒息患者,就地取材是关键,有经验的医护人员会用身边的钢笔、刀具等尖锐物切开环甲膜。

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