重症医学科患者气管切开术后并发症的防治研究  

Prevention methods for patient with complication caused by tracheotomy at critical care department

作　　者：王会青[1] 亢宏山[1] 杜智勇[1] 张红[1] 刘亚晶[1] 刘淑红[1] 崔朝勃[1] 

机构地区：[1]衡水市哈励逊国际和平医院重症医学科,河北053000

出　　处：《中国急救复苏与灾害医学杂志》2014年第12期1103-1106,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省衡水市科学技术研究与发展计划项目（12014A）

摘　　要：目的探讨重症医学科患者气管切开术后并发症及其防治。方法采用前瞻性随机对照的方法，选择2012年5月～2014年5月重症医学科行气管切开患者94例的临床资料。按带管时间（14d为界）分成两组。带管时间≤14d40例，带管时间〉14d54例。33例患者采用传统气管切开术（OT），61例采用经皮气管切开术（PDT）。对实施气管切开术后出现的最严重四大并发症：脱管、下呼吸道感染、气管食管瘘、气管大出血，结合其临床资料对其发生的原因及防治方法进行具体的分析探讨。并探讨OT患者与PDT患者气管切开术后并发症发生率。结果94例患者中25例发生严重并发症，其中脱管1例，下呼吸道感染20例，气管食管瘘2例，气管大出血2例。气管切开术后带管时间≤14d的患者并发症发生率为10．0％（4／40），明显低于带管时间〉14d患者的37．0％（20／54），P〈0．01。其中带管时间〉14d的患者下呼吸道感染的发生率也明显高于带管时间≤14d的患者（24．0％（20／54）比10．0％（4／40），P〈0．05]。OT患者气管切开术后并发症发生率比较差异无统计学意义（P〉0．05）。结论脱管、下呼吸道感染、气管食管瘘、气管大出血、皮下气肿、声门下肉芽肿等是重症医学科危重患者气管切开术后并发症，其中前四位是较为严重的并发症。行气管切开术时，严格掌握其适应症，应选择适当的气管套管，要有娴熟的操作技术，尽量减少带管时间，及时应用有效的抗生素及保持呼吸道通畅等。在适应症允许的情况下，采用PDT可以更加迅速、微创、简易地实现重症医学科危重患者的抢救及治疗。Objective To explore the prevention methods for the patients with with complication after tracheotomy. Methods The clinical data on 94 patients undergone tracheotomy in between May 2012 and May 2014 was reviewed and analyzed with prospective comparison method. The patients were divided into two groups-group A of 40 patients who carried tube for 14 days or less and group B of 54 patients who carried tube more than 14 days. 33 cases of the total of 94 were performed with conventional traeheotomy （OT） while the 61 with percutaneous tracheotomy （PDT）. Concerning the four major complications after traeheotomy on these cases-tube dropped off, the lower respiratory infection, tracheoesophageal fistula, and trachea hemorrhage, their causes and all possible prevention and treatment options were discussed and analyzed. Results 25 of the 94 cases were found severe complications, including 1 tube dropped off, 20 lower respiratory infection, 2 tracheoesophageal fistula, and 2 trachea hemorrhage. It reflected 10% of complications incidence in group A （4/ 40）, significantly lower than the 37% in group B （20/54）, （P 〈0.01）. In addition, group A＇s lower respiratory infection was also significantly lower than group B, 10.0% （4/40） vs. 24.0% （20/54）, （P 〈0.05）. No statistical difference was found between OT and PDT patients in complication after tracheotomy （P〉 0.05）. Conclusion Skillful tracheotomy, reduced tube carrying time, timely antibiotics, and keeping unobstructed respiratory airway are considered being the critical points in significantly lowering the chance of complication after tracheotomy.Also, PDT carries the features of being quick, minimally invasive, simple and easy, which realizes the effective treatment in critical care department.

关 键 词：气管切开术 手术后并发症 防治 

分 类 号：R4[医药卫生—临床医学]