太危险!骨头卡牢食管紧逼心脏主动脉,25岁女孩住进了重症监护室......

2022-08-27 邵逸夫医院 邵逸夫医院

被骨头or鱼刺卡住,千万不要喝醋!

7月30日晚, 25岁姑娘小楠(化名)休息在家,炖了一锅乌鸡汤,和男友一起品尝。鸡汤很鲜,小楠忍不住喝了一口又一口。
 
突然,小楠放下碗,面色有点紧张,“不好,吞下了一根鸡骨头,好像卡住了。”她跟男友说。
 
喝醋,吞饭团,小楠想借此把鸡骨头带下去,刚开始只是咽口水疼,没想到,过了一个多小时,她开始感觉胸骨后疼痛。
 
太危险!骨头卡牢食管紧逼心脏主动脉
 
在衢州当地医院急诊,医生给小楠做了CT,结果显示,小楠的食管上段位置有个异物,应该就是那块卡牢的鸡骨头。
 
“骨头卡牢的位置紧贴主动脉弓,非常危险,建议你们去大医院处理。”
 
如果单纯通过食管镜或胃镜取鸡骨头,当地医院技术是没问题的。但由于这块骨头卡牢的位置实在凶险,万一取骨头的过程中造成食管破裂、穿孔甚至戳破主动脉弓,后果就不堪设想。考虑到手术风险太大,当地医院果断建议小楠尽快转院到大医院。
 
于是,当天深夜,120救护车载着小楠,疾驰在衢州前往杭州的高速上。凌晨,小楠被推进浙江大学医学院附属邵逸夫医院庆春院区急诊。
 
“患者来的时候,胸骨疼痛表现还是比较明显,我们马上安排做各项检查。”邵逸夫医院急诊医学科陈棚棚医生说。
 
虽然当地医院已有一些检查资料,但小楠一路高速颠簸而来,病情是否有进展,需要进一步检查明确。
 
随后的胸部CT、主动脉增强CT检查显示,鸡骨头卡牢的位置离主动脉弓非常近(供应大脑血液的颈动脉,就是从主动脉弓发出的。食管有一段是跟主动脉贴牢的,骨头恰好卡在这里)。
 
“当时检查发现食管穿孔和动脉破裂的依据不是很足,但CT对于食管穿孔及主动脉破裂的敏感度有限,我们需要按照最坏结果做好预案,我们请了心超医生前来检查,同样发现骨头所在位置和动脉壁仅一壁之隔。”陈棚棚说。
 
这意味着,如果骨头刺穿食管,细菌就会跑到纵膈软组织,容易造成纵膈感染,而一旦骨头刺破主动脉弓,那么其导致的出血随时会危及生命。
 
惊险“拆雷”,顺利取出异物!
 
凌晨的邵逸夫医院急诊抢救室内,消化内科、耳鼻咽喉头颈外科、胸外科、超声科、心脏外科、体外循环小组等多学科医生快速集结。
 
消化内科和耳鼻咽喉科医生率先评估,讨论如何取出异物,接着,心脏外科值班医生请示了科主任钱希明主任医师后,同胸外科医生一起也制定了在手术当中如何保护血管以及一旦发生动脉损伤后抢救的预案。
 
“根据影像学结果,我们考虑过用微创介入的方法,在大血管内放个支架,这样即便取骨头时戳到大动脉,支架也能起到保护作用”,邵逸夫医院心脏外科翁家侃医生介绍,“但现无确切证据表明骨头戳破主动脉,也无必要预先放支架防止出血。因此我们把各种极端的可能都做了预案,不希望‘食管重建’、‘主动脉置换’这样的大手术在发生在患者身上,决定先行胃镜探查骨头位置后再定手术方案。”    
 
图片胃镜取骨头
 
经多学科讨论,决定启用杂交手术室,全麻下插管下进行手术。因为小楠的直系亲属在外地,术前,医院通过电话得到了家属授权。
 
周六清晨,杂交手术室、各相关科室医生待命,消化内科林讷医师操作胃镜,开始耐心细致地寻找并取异物。
 
胃镜术中发现,鸡骨头一头很尖锐,扎进了食管壁,万幸的是,尖头刺入的方向是倾斜的,根据经验,医生判断,这种情况下即使扎入比较深,往往也未完全穿透食管壁,还是有内镜下夹闭的机会的。
 
林讷医师小心翼翼,先从没有刺入的另一端入手,慢慢地仔细地操作,这根一厘米多长的要命的鸡骨头终于被顺利取出,在场所有人都长舒一口气。
 
随后,胃镜再次进入观察,发现食管壁虽然损伤覆盖血迹,但相对完整,为了保护受损的食管壁,医生利用胃镜置入一根营养管到患者的小肠里,这样既解决了营养支持的问题,又能避免让食管壁的损伤感染加重。
 
术后,小楠被转到重症监护病房密切观察,预防纵膈感染等并发症,进行空肠营养支持,加强康复并进行心理疏导。
 
“患者现在生命体征稳定,食管壁损伤粘膜也在慢慢恢复。如果一切顺利,她很快就可以出院了。”邵逸夫医院重症医学科王勇刚副主任医师介绍。
 
图片取出的鸡骨头,长约1厘米左右,一头尖锐
 
喝醋能不能软化鱼刺、骨头?
 
陈棚棚医生介绍,邵逸夫医院急诊科每年都会接诊不少异物卡喉患者,鱼刺卡喉最多,被各种骨头卡喉的也不少,不少人就诊前,都曾尝试喝醋软化异物,或者吞咽饭团想把异物带走。
 
那醋到底能不能软化鱼刺、骨头?
 
我们来通过实验告诉大家:分别选取鸡爪的爪根和爪尖部分骨头、河鱼的细刺和鱼肚子部分大刺,分别放入总酸≥4.50g/100ml的陈醋内浸泡。17:36开始,4小时后,取出浸泡的鱼刺和鸡爪骨头,两者的颜色都有加深,但骨头依旧坚硬,而五根鱼刺中的四根依旧锋利坚韧,只有那根极细的鱼刺,浸泡后稍有些变软。
 
图片图片
 
王勇刚医生表示:“喝醋、吞米饭、馒头都是加重病情的错误方法。浓度太高太酸的醋会损伤食管与胃黏膜,加重局部的损伤,对卡牢的异物起不到软化作用。而当大口吞饭团时,因为食管壁既薄又软,吞咽饭团会把尖锐的异物钉入食管壁,甚至越挤越深,有些甚至会穿破食管壁刺入临近的重要器官,引发大出血、感染等严重后果。”
 
无论是被鱼刺,还是其他异物卡牢,立即就医、尽早寻求医生帮助、及时取出异物是最正确的办法!
 
骨头/鱼刺卡在喉咙到底该怎么办?
 
1.千万不要试图用饭团、馒头把鱼刺吞进去,因为可能会把原本位置比较浅的鱼刺推得很深。也不要奢望喝醋能把骨头/鱼刺给“软化”了,可能它一动不动,你的口腔、食道粘膜先被烧伤了。
 
2.可以让家人拿手电照照看,如果张开嘴就能见到骨头/鱼刺,我们可以用镊子或者夹子或筷子取出来,但是千万不要用手去抠。
 
3.如果卡在喉咙比较浅的地方,可以尝试着咳嗽,把它咳出,或者用手指压住舌根使其呕吐,让它顺着呕吐物带出来。
 
4.当你尝试以上方法还是不能把骨头/鱼刺弄出来,就要及时就医了,以免耽误最佳治疗时机。
 
吃鱼小诀窍
 
最后,想为为大家献上一份”吃鱼小诀窍“,希望大家在满足口腹之欲的同时要保护好自己。
  • 首先,吃鱼的时候用舌尖和牙齿仔细分辨鱼刺。因为舌尖的神经丰富,感觉最敏锐。一定要细嚼慢咽,心急吃不了热豆腐。
  • 其次,吃鱼的时候一定要专心,不要一口鱼肉一口饭,也不要说话,不要玩手机,不要心不在焉。
  • 值得注意的是,家里的儿童和老人,尽量吃没有小刺的鱼,或者吃剔除了鱼刺的鱼肉。
 
图片

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    2023-02-12 redcrab
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    2022-08-27 xulv123

    认真学习~~

    0

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    2022-08-26 zhouqu_8
  5. [GetPortalCommentsPageByObjectIdResponse(id=1721881, encodeId=c0381e21881fc, content=<a href='/topic/show?id=01811016363e' target=_blank style='color:#2F92EE;'>#骨头#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101636, encryptionId=01811016363e, topicName=骨头)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cd033099978, createdName=redcrab, createdTime=Sun Feb 12 17:45:09 CST 2023, time=2023-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241343, encodeId=3150124134397, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sat Aug 27 10:09:56 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415852, encodeId=6de414158520e, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri Aug 26 08:45:09 CST 2022, time=2022-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437772, encodeId=82d7143e77212, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Aug 26 08:45:09 CST 2022, time=2022-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551234, encodeId=1d0e155123425, content=<a href='/topic/show?id=e2c1e230796' target=_blank style='color:#2F92EE;'>#监护#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72307, encryptionId=e2c1e230796, topicName=监护)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=477814173963, createdName=bioon6, createdTime=Fri Aug 26 08:45:09 CST 2022, time=2022-08-26, status=1, ipAttribution=)]
    2022-08-26 bioon6

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