气管切开术后气道狭窄的临床分析

目的 分析和探讨经皮气管切开术后气道狭窄的发生情况及原因。方法回顾分析2015年6月~2016年6月我院接诊的气管切开后气管狭窄需第二次气管切开术24例患者的临床资料。结果5例气道狭窄患者为接受开放性气管切开术的患者,19气道狭窄患者为接受经皮气管切开术的患者。经皮气管切开手术后气道狭窄的占有比例为86.4%；发生气道环形狭窄的患者17例,发生气道肉芽增生后狭窄的患者7例,气道环形狭窄发生率为70.8%；狭窄发生在第一气管环及患者软骨的患者为20例,发生于其他气管环的患者4例；经皮气管切开术导致的气道狭窄中气管环形狭窄占有比例84.2%,开放性气管切开术患者中气管环形狭窄占有比例为20%,两者有统计学差异。气管环形狭窄多发生在气管切开后15~30天内,肉芽组织增生狭窄多发生在气管切开术后2~3月内。结论经皮气管切开术在技术不熟练的情况下容易出现气管狭窄,其中多以发生在第一气管环及环状软骨的环形缩窄为主,这与经皮气管切开时气管切开部位不准确,伤及环状软骨有关。

Clinical Analysis of Airway Stenosis Caused by the Tracheostomy

Objective To analyze and evaluate the incidence and causes of airway stenosis caused by the tracheostomy.MethodsThe clinical data of 24 patients with tracheal stenosis after first tracheostomy which needed to accept second tracheostomy from June 2015 to June 2016 in our hospital were reviewed and analyzed.Results5 patients of airway stenosis underwent open tracheostomy firstly,and 19 patients underwent percutaneous tracheostomy,whose proportion of percutaneous tracheotomy leading to airway stenosis was 86.4%.Airway stenosis of 17 cases belonged to annular airway stenosis,and 7 cases of air stenosis attributed to to airway granulation.The rate of airway annular stenosis was 70.8%.Area of airway stenosis of 20 patients located in throat annular cartilage and first tracheal ring,and 4 cases located in other tracheal rings The occupation ratio of annular airway stenosis for patients who accepted percutaneous tracheotomy was 84.2%,for which patients who accepted open tracheotomy accounted for 20%,and the difference was both significant.Air annular stenosis occurred within 15~30 days after tracheotomy,and granulation tissue hyperplasia stenosis occurred within 2~3 months after tracheotomy.ConclusionPercutaneous tracheostomy in unskilled condition was prone to resulting in tracheal stenosis,which occurred mainly in throat annular cartilage and first tracheal ring,and resulted from the wrong open location of percutaneous tracheotomy,making the throat annular cartilage damaged.