长期机械通气并发气管内肉芽的处理策略  

Management strategies of granulation in tracheal post-tracheostomy caused by prolonged mechanical ventilation

作　　者：杨弋[1] 王利一[1] 张雷[1] 王晓云[1] 宋海涛[1] 黄魏宁[1] YANG Yi;WANG Liyi;ZHANG Lei;WANG Xiaoyun;SONG Haitao;HUANG Weining(Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China)

机构地区：[1]北京医院国家老年医学中心耳鼻咽喉科,北京100730

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第11期857-859,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨采取不同方法治疗气管切开后长期机械通气并发气管内肉芽的老年患者的疗效及安全性。方法:216例>70岁的老年患者中有44例(20.4%)气管内肉芽形成,肉芽形成时间在气管切开术后2~25个月,平均(14.0±3.2)个月。其中Ⅰ度12例,Ⅱ度18例,Ⅲ度14例。Ⅰ~Ⅱ度(共30例)患者予以更换可调节气管套管;14例Ⅲ度患者气管肉芽组织增生,行钬激光切除。结果:44例老年患者治疗过程顺利,未发生气道穿孔、出血不止及窒息等并发症。术后症状完全消失,内镜检查可见气道通畅。随访无复发。结论:更换可调节气管套管和钬激光可安全、有效地治疗气管切开术后气管内肉芽组织增生所致的气道梗阻。Objective：To analyze the effect and safety of treatment in patients with airway stenosis caused by tracheotomy for mechanical ventilation.Method：We treated the patients with airway stenosis caused by granulation tissue.The patients with gradeⅠ,Ⅱ airway stenosis were treated with adjustable flange tracheostomy tube,and the holmium laser under a fibro-laryngoscope were applied for the patients with gradeⅢairway stenosis.Two hundred and sixteen patients were enrolled in this study.Forty-four patients had been found tracheal stenosis caused by granulomatous hyperplasia,accounting for 20.4% of all patients,including 12 cases of gradeⅠ,18 cases of gradeⅡ,and 14 cases of gradeⅢ.Result：Thirty patients with gradeⅠandⅡ were replaced with adjustable flange tracheostomy cannula.Fourteen cases of gradeⅢ airway stenosis were treated with Ho：YAG laser under a fibro laryngoscope.All cases were completed operation successfully.None of cases bleeding,perforated and asphyxia during operation.The clinical symptoms disappeared after operation,and endoscopy showed that airways of patients were smooth.No recurrence were found after operation.Conclusion：Replacement of adjustable flange tracheostomy tube and Ho：YAG laser can safely and effectively treat airway obstruction caused by tracheal granulation tissue hyperplasia after tracheotomy.

关 键 词：气管切开术 气道狭窄 钬激光 气管套管 肉芽组织 

分 类 号：R768[医药卫生—耳鼻咽喉科]