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患者,女,17岁。1993年6月23日入院。伴送者代述:昨日患者所乘坐的客车与一辆解放牌货车相撞,急刹车后,患者颈部碰撞在前排客座的铁扶杆上,当即出现呼吸困难,持续约10分钟,伴失音。入院体检:患者呼吸平稳,失音,以摇头及点头示意,处于坐位,头、颈、胸前倾。拒绝颈部触诊,颈前区皮肤呈长条形擦伤至左锁骨上窝处,约16cm×2.0cm。口咽部正常,间接喉镜检查:双侧声带外展位,内收受限,左侧声带后1/3可见出血,余无异常发现。入院诊断:①喉挫伤,②颈部皮肤擦伤。入院当天至次日,患者均出现一次吸气性呼吸困难,伴有口唇紫绀,持续约4分钟后缓解。6月25日凌晨1时,患者出现持续性吸气性呼吸困难,经给氧、静脉推注地塞米松后无缓解,遂行气管切开术。术中一直未扪到
Patient, female, 17 years old. June 23, 1993 admission. With the sender on behalf of: Yesterday, the patient bus ride and a Jiefang license plate truck collided with a sudden brake, the patient’s neck collided with the front passenger’s iron strut, immediately appeared dyspnea, lasted about 10 minutes, with aphonia. Admission medical examination: patients with stable breathing, aphonia, shook his head and nodded, in the seat, head, neck, chest tilt. Refused neck palpation, neck area of the skin was a long strip of abrasions to the left supraclavicular fossa, about 16cm × 2.0cm. Oropharyngeal normal, indirect laryngoscopy: bilateral vocal abduction, adduction limited, the left vocal cords after the 1/3 bleeding, I found no abnormalities. Admission diagnosis: ① throat contusion, ② neck skin abrasions. From the day of admission to the next day, the patient developed an inspiratory dyspnea accompanied by cyanosis of their lips, which was relieved after about 4 minutes. At 1:00 on June 25, patients with persistent inspiratory dyspnea, after giving oxygen, intravenous dexamethasone without remission, then tracheotomy. Intraoperative has not palpable