经皮气管切开术后并发气管狭窄的相关因素分析

目的 分析经皮气管切开术后气管狭窄的影响因素,并探讨其对策.方法 选择2006年2月至2012年6月行经皮气管切开术286例患者为研究对象,就术后机械通气时间、气道反复感染、糖皮质激素不合理应用、气管切开位置过高和操作方法不当5种因素,采用Logistic回归进行多因素分析.结果 286例患者中发生气管狭窄43例,发生率为15.03％（43/286）.多因素分析结果表明,术后机械通气时间过长（x2=21.76,P＜0.01）,反复气道感染（r=18.21,P＜0.01）,糖皮质激素不合理应用（x2=9.65,P＜0.01）,气管切开位置过高（x2=4.51,P＜0.05）,操作方法不当（x2=4.33,P＜ 0.05）与术后并发气管狭窄有关.结论 经皮气管切开术后造成气管狭窄的影响因素是多方面的,术后机械通气时间和反复气道感染是其主要原因,其次是糖皮质激素不合理应用、气管切开位置过高及操作方法不当.

The correlative factors of tracheal stenosis after percutaneous tracheostomy

Objective To analyze the correlative factors of tracheal stenosis after percutaneous tracheostomy,and to explore its contermeasures.Methods Two hundreds and eighty-six patients from February 2006 to June 2012 with percutaneous tracheostomy were selected.Five correlative factors including machinery ventilation time after operation,airway infection repeatedly,irrational use of ghcocorticoid,high position of tracheotomy and operation improper method were analyzed through Logistic regression analysis.Results Tracheal stenosis occurred in 43 cases,and the incidence rate was 15.03% （43/286）.Multivariable analysis results showed that machinery ventilation time after operation for too long （x2 =21.76,P 〈 0.01）,airway infection repeatedly （x2 =18.21,P 〈 0.01）,irrational use of glucocorticoid （x2 =9.65,P 〈 0.01）,high position of tracheotomy （x2 =4.51,P 〈 0.05） and operation improper method （x2 =4.33,P 〈 0.05） were associated with postoperative concurrent tracheal stenosis.Conclusions There are many factors coreelate to tracheal stenosis after percutaneous tracheostomy,in which the machinery ventilation time after operation and airway infection repeatedly are the main reasons,and irrational use of glucocorticoid,high position of tracheotomy and operation improper method are secondary causes.