气管切开术在脑卒中患者中的应用  

The significance of tracheostomy in cerebrovascular disorders

作　　者：倪富强[1] 李红艳[1] 周晖[1] 伊海金[1] 刘丕楠[1] 

机构地区：[1]首都医科大学附属北京天坛医院耳鼻咽喉科,100050

出　　处：《北京医学》2009年第7期411-413,共3页Beijing Medical Journal

摘　　要：目的总结气管切开对脑卒中患者的抢救治疗意义、适应证、手术特点及并发症。方法回顾性分析110例行紧急气管切开术脑卒中患者的资料。结果110例患者中合并严重颈椎病采用平卧位手术者5例。术中出现呼吸暂停而先行气管插管再行气管切开者6例。抗凝治疗凝血功能下降术中使用双极电凝止血8例,合并肺气肿肺尖上移4例,置管时出现长时间屏气血氧饱和度一过性严重下降者6例。出现并发症16例(14.5%),其中因术后伤口渗血行油纱条局部压迫止血者5例,二次手术止血3例,皮下气肿5例,脱管3例,气管内套管阻塞1例。94例患者好转拔管,13例带管回家,3例死于原发病。结论气管切开术对脑卒中患者抢救生命、减少并发症及促进早日康复有重要意义,手术有一定的特点,应采取相应的灵活处理方法。Objective To explore the value of trachecstomy in patients with cerebrovascular disorders,its indication of operation approaches and complications. Methords 110 patients＇ data were reviewed retrospectively. All were operated with surgical trachecstomy. Resullts Five cases complicated with severe cervical spondylosis were applied prostration operation, 6 cases were operated with tracheostomy after endotreacheal intubation because of apnea. Eight cases were applied bipolar electrocoagulation because the patients had anticoagulant therapy, 4 cases were found to have elevated pulmonis apex because of emphysema. Six cases had long breathholding during intubation which led to blood oxygen saturation decline. There were 16 complications events, accounting for 14.5% of the total cases. Five cases with errhysis were treated with local pressure with gauze, 3 cases were re - operated for bleeding control. Five cases had pneumohypedema. Collapse of canal occurred in 3 patients. Ninety four cases were decannulated, 13 cases left hospital with intubafion. Three cases died from their primary disease. Conclusions Tracbeostomy has important value for early recovery and reducing complications in patients with cerebrovascular disorders. This operation has its unique characteristics, so the approach should be individualiged.

关 键 词：气管切开术 脑卒中 适应证 并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]