颈髓损伤机械通气并发气管食管瘘的原因分析和防治措施  

Reasons and Control Measures of Tracheoesophageal Fistula Caused by Mechanical Ventilation for the Treatment of Cervical Spinal Cord Injury

作　　者：孙群周[1] 高向鸟 李凤春[1] 孟庆阳[1] SUN Qun-zhou;GAO Xiang-niao;LI Feng-chun;MENG Qing-yang(Luoyang Traditional Chinese Orthopedics and Traumatic Hospital of Henan,Luoyang 471002 China)

机构地区：[1]河南省洛阳正骨医院,河南洛阳471000

出　　处：《食管疾病》2020年第3期219-221,共3页Journal of Esophageal Diseases

摘　　要：目的探讨颈髓损伤气管切开机械通气并发气管食管瘘的原因及防治措施。方法对2007年5月至2018年3月因颈髓损伤气管切开机械通气并发5例气管食管瘘患者的临床资料和相关文献进行检索,分析其发生的原因,探讨气管食管瘘的预防处理措施。结果机械通气患者发生气管食管瘘与气囊压力过高、气囊压迫时间过长、呼吸机管道重力压迫气管后壁、套管不稳定活动增多、营养不良、肺部感染等因素有关。预防和治疗措施主要是常规监测气囊内压、避免压力过高、妥善固定气管套管、减轻呼吸机管道对气管后壁的压迫、积极缩短机械性通气时间、治疗肺部感染、加强肠内营养等。结论加强对机械性通气患者人工气道与气囊的管理,能最大限度减轻气管内膜的机械性损伤,降低气管食管瘘的发生率,空肠造瘘有利于改善机体营养,促进瘘口愈合。Objective To explore the reasons and control measures of tracheoesophageal fistula caused by mechanical ventilation for the treatment of cervical spinal cord injury. Methods The clinical data and relevant literatures of 5 cases with cervical spinal cord injury complicated with tracheoesophageal fistula from May 2007 to March 2018 were reviewed, the reasons and control measures of the disease were described. Results Tracheoesophageal fistula might be caused by higher cuff pressure, long time of cuff oppression, oppression on tracheal wall by ventilator pipe, instable activities of endotracheal tube, malnutrition and pulmonary infection, etc. Main preventive measures included monitoring cuff pressure routinely, avoiding higher cuff pressure, fixing endotracheal tube properly, alleviating pressure on the tracheal wall, shortening the time of mechanical ventilation, treating pulmonary infection and enhancing enteral nutrition. Conclusion For patients with mechanical ventilation, enhanced administration of the artificial airway and endotracheal tube cuff can largely alleviate the damage of trachea membrane and reduce the incidence of tracheoesophageal fistula;jejunostomy is good for improvement of body nutrition and promote healing.

关 键 词：颈髓损伤 呼吸机 气管切开术 气管食管瘘 

分 类 号：R683.42[医药卫生—骨科学]