带内套管外带套囊的气管套管在喉癌和下咽癌术后并发症治疗中的应用策略及效果  

Application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal or hypopharyngeal cancer

作　　者：袁锦锦 李大鹏 刘业海[1] 吴开乐[1] 赵益[1] 吴静[1] 姚长玉[1] 王杨[1] Yuan Jinjin;Li Dapeng;Liu Yehai;Wu Kaile;Zhao Yi;Wu Jing;Yao Changyu;Wang Yang(Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉头颈外科,合肥230022

出　　处：《中华肿瘤杂志》2020年第11期976-979,共4页Chinese Journal of Oncology

摘　　要：目的探讨带内套管外带套囊的气管套管在治疗喉癌和下咽癌术后严重并发症中的应用策略,评价其治疗效果,方法60例在喉癌和下咽癌术后出现严重并发症的患者,其中术后发生严重颈部感染31例,呼吸困难8例,创面大出血5例,严重呛咳16例。出现并发症后,立即给患者佩戴带内套管外带套囊的气管套管,封闭气管套囊,再根据不同的并发症行不同的处理对严重颈部感染者,气囊充气,防止颈部分泌物误吸至气管对呼吸困难者,立即接呼吸机辅助通气。对创面大出血者,应防止出血误吸,并在全麻下止血。对严重呛咳者,进行饮食训练,防食物误吸所有患者每月更换1次气管套管结果60例患者的并发症均得到有效控制。31例颈部感染患者,经过换药治疗颈部创面缩小或愈合,最后均更换金属气管套管。8例呼吸困难患者,经过对症及相关专科治疗,最后均更换金属气管套管5例颈部创面大出血的患者,均抢救成功,并更换为金属气管套管,16例严重误吸呛咳者,13例拔除气管套管,3例患者因年老体弱、病情较重更换为金属气管套管结论在喉癌和下咽癌术后严重并发症的治疗中,应用带内套管外带套囊的气管套管取得了良好效果,有重要临床价值。Objective To Investigate ihe application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer.Methods A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications,including 31 cases of severe postoperative neck infection,8 cases of dyspnea,5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration.The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated.Different treatments were carried out according to different complications.The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea.Patients with dyspnea immediately received ventilator-assisted ventilation.For those with massive hemorrhage on the wound,doctors should prevent bleeding and stop bleeding under general anesthesia.Patients with severely coughing should perform eating training to prevent food aspiration.The inner cannula was regularly replaced once a month for all of these patients.Results Through targeted treatment,the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled.After dressing change,the neck wounds of 31 patients with neck infection were shrunk or healed.Finally,all of the patients were replaced with metal tracheal tubes.Eight cases with dyspnea were rescuetl with the symptomatic and related special treatment,and finally replace by metal tracheal tube.Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula.Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula.Conclusions The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryn

关 键 词：气管套管 喉肿瘤 下咽肿瘤 并发症 

分 类 号：R739.6[医药卫生—肿瘤]