减少高龄患者气管切开术后并发症的治疗策略  

Treatment strategies for reducing complications of tracheotomy in high risk elderly patients

作　　者：杨弋[1] 陈宏[1] 张雷[1] 王晓云[1] 宋海涛[1] 黄魏宁[1] YANG Yi;CHEN Hong;ZHANG Lei;WANG Xiao-yun;SONG Hai-tao;HUANG Wei-ning(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喉科,北京100730

出　　处：《中国医刊》2018年第6期643-645,共3页Chinese Journal of Medicine

摘　　要：目的回顾性分析高龄(≥75岁)患者气管切开手术的术前评估与手术体会,探讨保证手术安全和有效减少术后并发症的策略。方法回顾性分析2011年1月至2015年12月在本院行气管切开术的74例高龄(≥75岁)患者的临床资料。术前详细评估患者病情,包括年龄、性别、手术指征、全身情况、颈部情况、伴随疾病、抗凝药物使用史、插管时间等,术后详细记录手术相关并发症。结果所有患者均顺利完成气管切开手术,其中3例患者因甲状腺肥大,切开甲状腺峡部并缝扎后完成手术。2例患者术后发生严重出血,其中1例使用凡士林纱条压迫48小时后出血停止,另1例患者压迫止血无效,行二次手术缝扎止血。4例血液透析患者手术前后24小时使用无肝素透析。无其他并发症发生。结论高龄患者气管切开手术的风险较高,但通过恰当的术前评估并采取相应的措施可提高手术安全性及减少术后并发症。Objective To retrospectively analyze the tracheotomy in elderly patients aged 75 years and over,and to explore the surgical strategy for ensuring the safety of surgery and reducing the complications. Method The clinical data of the patients who underwent tracheotomy at our institute from January 2011 to December 2015 were reviewed. The data include general condition, accompany disease, the neck, the use of anticoagulant, treatment and operation were recorded and analyzed. Result In this study, we analyzed the data from 74 patients. All cases were intubated endotracheal before operation, and tracheotomy was performed successfully. the thyroid isthmus were cutted and ligated in 3 cases for completing the operation. Postoperative bleeding occurred in 2 cases, 1 case stopped the bleeding with vaseline gauze plugging, the surgical field was reexposed for hemostasis in another case. Without heparin hemodialysis were selected for 4 cases in 24 hours before and after surgery. No other complications occurred. Conclusion Patients with aged 75 years and over have high risks of tracheotomy. But after correct and appropriate preoperative assessment and taking actions accordingly, it can ensure safety of surgery and reduce the complications.

关 键 词：老年人 气管切开术 手术后并发症 

分 类 号：R653[医药卫生—外科学]