小儿气管切开患者术后气道管理模式安全性探讨

Safety of postoperative airway management in children with tracheotomy

目的探讨术后气道管理对小儿气管切开患者疾病转归康复的安全性影响。方法选取回顾烟台市某三甲医院2020年01月-2021年01月期间23例行气管切开术的小儿患者(年龄≤13岁),分别从术后并发症、术后气道护理、术后呼吸治疗以及平均住院日等方面对小儿气管切开患者术后气道管理模式安全性进行评估。结果小儿气管切开患者术后平均住院(39.01±1.24)天。首次气管套管更换在平均术后第6天进行,气管造口管平均日进行床旁护理操作和呼吸治疗(5.98±1.23)次,从患者行气管切开术到出院之间进行床旁护理操作和呼吸治疗达到(214±2.54)次。在此期间,共发生气管造口相关并发症6例:其中3例是非计划拔管导致心脏骤停,1例为术后出血导致呼吸困难窒息,2例发生气道感染。气管套管放置后2周内日床旁护理操作和呼吸治疗超过4次手术患者比少于4次的手术患者更有可能发生气管切开术后相关并发症(P=0.0349)。结论对于小儿气管切开患者来说,在病情允许的情况下,减少日床旁护理操作和呼吸治疗次数,缩短平均住院时间能有效减少发生气管切开术后相关并发症,对小儿气管切开患者疾病转归康复具有一定积极意义。

Objective To explore the safety effect of postoperative airway management on disease outcome and rehabilitation of children with tracheotomy.Methods A total of 23 pediatric patients(aged≤13 years)undergoing tracheotomy from January 2020 to January 2021 in a 3A hospital in Yantai were selected and reviewed.The safety of postoperative airway management modes for pediatric patients undergoing tracheotomy was evaluated from aspects of postoperative complications,postoperative airway care,postoperative respiratory therapy,and average hospital stay,respectively.Results The average hospitalization days of children after tracheotomy were(39.01±1.24)days.The first tracheal cannula replacement was performed on the average sixth day after surgery,and the tracheostomy tube was subjected to bedside care operations and respiratory therapy(5.98±1.23)times a day on average.The number of bedside care operations and respiratory therapy from the time the patient underwent tracheotomy to her discharge from hospital was(214±2.54)times.During this period,a total of six cases of tracheostomy-related complications occurred:three cases of cardiac arrest caused by unscheduled extubation,one case of dyspnea asphyxia caused by postoperative bleeding,and two cases of airway infection.Patient who had undergone more than four surgeries in daily bedside nurse operation and respiratory therapy within two weeks after tracheal cannula placement were more likely to have complications associate with tracheotomy than patients who had undergone fewer than four surgeries(P=0.0349)。Conclusion For children with tracheotomy,reducing the number of bedside nursing operations and respiratory therapy and the average hospital stay can effectively reduce the complications after tracheotomy,which has a positive significance for the disease outcome and rehabilitation of children with tracheotomy.