80岁以上老年人长期气管切开术后并发症的原因分析

目的探讨≥80岁老年患者长期气管切开术后并发症发生的原因及防治措施。方法回顾性分析2004年2月至2011年8月我院收治的≥60岁资料完整的行气管切开术350例患者临床资料,其中就气管切开后带套管较长时间的80例≥80岁老年患者的主要并发症原因及防治进行分析。结果 80例长期带管≥80岁老年患者其并发症最多见为反复肺部感染38例(47.50%),其合并多种致病菌,致病菌以铜绿假单胞菌为主,治疗棘手,是死亡的主要原因。其后依次为拔管困难15例(18.75%)、气管内出血14例(17.50%)、伤口渗血5例(6.25%)、套管堵塞4例(5.00%)、肺大泡3例(3.75%)、气管食管瘘1例(1.25%)。结论≥80岁老年气管切开术后带套管患者由于多种疾病并存,常合并多器官功能不全,凝血机制障碍,长期带管等都是气管切开术后并发症发生的主要危险因素。针对危险因素,做好并发症预防,可延缓患者生命。

Reason analysis of complication in the very elderly undergoing long-term tracheotomy

Objective To investigate the reason and preventive measure of complication in the very elderly undergoing long-term tracheotomy. Methods 350 inpatients’ clinical datas (≥60 years old) span from February 2004 to August 2011 were retrospetively analyzed, and the reason and preventive measure of major complication in 80 inpatients aged ≥80 with long-term tracheal cannula were investigated. Results The frequent complication in 80 inpatients aged ≥80 with long-term tracheal cannula were iterative pulmonary infection(38 cases), difficulty in decannulation(15 cases), trachea hemorrhage(14 cases),wounds capillary hemorrhage(5 cases), cannula obstruct(4 cases), pneumatocele(3 cases), tracheoesophageal fistula(1 case).The incidence were 47.50%,18.75%,17.50%,6.25%, 5.00%, 3.75% and 1.25%, respectively. And the former was the major cause of death,combining multiple pathogenic bacteria, and Pseudomonas aeruginosa was the most frequent and difficult to be eliminated. Conclusions The very elderly patients undergoing long-term tracheotomy often suffer from many kinds of diseases, combining multi-organ impaired function and disturbances of blood coagulation. Long-term tracheal cannula is the major risk factor of the complication in patients undergoing tracheotomy. Against the risk factor, preventing complications is valuable to prolong life span.