患者,男,12岁。从3米高处坠落2小时。下颌部、胸部着地,伤后胸闷、呼吸困难、咯血。查体:气急、紫绀,下颌部见3cm伤口,颈过伸时呼吸困难加重,气管偏右,颈部触痛,面颈部、胸腹部可触及广泛皮下气肿,左胸廓饱满,触及骨擦感,叩诊呈鼓音,左肺呼吸音消失,右肺呼吸音增粗。胸片示:左第5、6肋骨骨折,左侧气胸,肺压缩约85％广泛性皮下气肿,纵隔气肿。入院后即行左胸腔闭式引流术,胸骨上凹切开排气,胸壁制动等抢救措施。3天后拔胸腔引流管,呼吸困难等症状消失。一周后又感胸闷,呼吸困难(呈吸气性呼吸困难),可闻及喘鸣音。CT扫描示:颈段第3、4气管环膜部向气管腔内不规则突出,气管截面积缩小约40％,纵行长约2cm。诊断:颈段气管不完全性断裂伴狭窄。即行气管切开,置T型管术,根据患者气管直径,选择内径0.9cm的硅酮橡胶管,截取适当长度,放置方法是用血管钳钳夹T型管的上支,将下支插入气管造口并推向远端,再将上支推入气管近端,然后用另一支血管钳钳夹并牵引T型管水平支,使T型管处于适当的位置。患者呼吸困难消失,术后用细吸引管通过水平支插入上支或下支进行间断吸痰,保持气道畅通。为防止粘液分泌物集聚在管壁上,术后应经常保持气道湿化,每日2次 Patient, male, 12 years old. Drop from 3 meters for 2 hours. Jaw, chest, chest tightness, dyspnea, hemoptysis. Physical examination: shortness of breath, cyanosis, the lower jaw see 3cm wound, neck dyspnea when exacerbation, trachea to the right, neck tenderness, face and neck, chest and abdomen can reach a wide range of subcutaneous emphysema, left chest full, touching the bone rub A sense of percussion was drum sound, left lung breath disappeared, right lung breath tone thickening. Chest X-ray showed: the first 5,6 rib fractures, left pneumothorax, pulmonary compression about 85% of extensive subcutaneous emphysema, mediastinal emphysema. After admission, left thoracic closed drainage, sternal concave cut open the exhaust, chest wall brake and other rescue measures. 3 days after the chest drainage tube, breathing difficulties and other symptoms disappear. A week later felt chest tightness, difficulty breathing (breathing difficulties breathing), can be heard and wheezing. CT scan showed that the third and fourth tracheal ring of the cervical section protruded irregularly into the tracheal lumen, the trachea cross-sectional area was reduced by about 40%, and the longitudinal length was about 2 cm. Diagnosis: incomplete tracheal neck fracture with stenosis. According to the diameter of the trachea, a silicone rubber tube with an inner diameter of 0.9 cm is selected and the proper length is taken. The method of placement is to clamp the upper branch of the T-tube with a vascular forceps and insert the lower branch into the trachea Stoma and push to the distal end, then push the upper branch into the proximal end of the trachea, and then use another vascular forceps clamp and traction T-tube horizontal branch, the T-tube in place. Patients with dyspnea disappeared after surgery with fine suction tube through the horizontal branch into the branch or branch for intermittent suction, keep the airway open. In order to prevent the accumulation of mucus secretions on the tube wall, the airway should be humidified after surgery, 2 times a day