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重症医学科患者气管切开术后并发症的防治研究
王会青1亢宏山2杜智勇3刘亚晶 4 刘淑红5崔朝勃 6
河北省衡水市哈励逊国际和平医院重症医学科 053000
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基金项目：河北省衡水市科学技术研究与发展计划项目（12014A）
作者单位：河北省衡水市哈励逊国际和平医院重症医学科衡水市人民东律180号053000通信作者：亢宏山 Email：kanghongshan@
中图分类号： R4 文献标识码： A 文章编号：1673-6966（2014）00-0000-00 doi：10.3969/j.issn.1673-6966.0000.00.000
【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月至2014年05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≤14d 40例，带管时间＞14d 54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。
【关键词】气管切开术；手术后并发症；防治
Patients with severe medicine study the prevention and cure of complications after tracheotomy
WANG Hui-qing,KANG Hong-shan,
Hebei hengshui 053000,China Harrison International Peace Hospital Intensive Medicine Corresponding author: Cui Chao-bo cuichaobo@
【Abstract 】Objective to study the patients with severe medicine and its prevention and treatment of complications after tracheotomy.Methods Adopt the method of prospective, randomized, controlled, the choice in May 2012 to May 2012 intensive medicine line of the clinical data of 94 patients with tracheotomy.Press the tube time (14 d bounded) into two groups.With tube time 14 d or less 40 cases with tube time > 14 d 54 cases.33 cases were treated by traditional tracheotomy (OT), 61 cases with percutaneous tracheotomy (PDT).For one of the worst four major complications after tracheotomy: take off the tube and the lower respiratory tract infection, tracheoesophageal fistula, trachea hemorrhage, combined with the clinical data in the concrete analysis, this paper discusses the cause and the prevention and treatment.And discuss OT with PDT with patients after tracheotomy in patients with complications.Result 25 cases occurred in 94 cases of patients with serious complications, including 1 pipe of cases, 20 cases of lower respiratory tract infection, tracheoesophageal fistula in 2 cases, trachea hemorrhage in 2 cases.Tracheotomy in patients with tube time 14 d or less after the incidence of complications was 10.0% (4/40), significantly lower than the 37.0% of the patients with tube time > 14 d (20/54), P < 0.01).Including 14 d with tube time > the incidence of patients with lower respiratory tract infection is significantly higher than patients with tube time 14 d or less than [24.0% (20/54), 10.0% (4/40), P < 0.05).OT after tracheotomy in patients with complications there was no statistical significance (P> 0.05) difference comparing.Conclusion techniques, decrease as far as possible with tube time, timely application of effective antibiotics, keep respiratory tract unobstructed, etc.Indications in the permission, the use of PDT can more quickly, minimally invasive, simple and easy to realize intensive medicine rescue and treatment of critically ill patients
【Key words 】tracheotomy postoperative complication prevention and cure
为积极救治危重患者通常需要气管切开，指南建议若评估患者不能早期拔出气管插管，应尽早给与气管切开[1]。而其常见并发症多为切口出血、切口感染、切口溢痰、切口瘢痕、套管脱落或阻塞、皮下或纵膈气肿等，且气管食管瘘、气管狭窄和气管大出血少见。重症医学科危重患者常因病情危重，气管切开术后需长期带管，往往会导致严重并发症的出现。我
