老年患者气管切开术后并发症的危险因素分析

Analysis of the risk factors for tracheostomy complications in elderly patients

目的探讨老年患者气管切开术后并发症发生的相关因素及防治措施。方法回顾性分析1989年10月至2005年8月80例80～102岁行气管切开术的老年患者的病历资料,采用Logistic 回归对可能导致并发症的13个临床因素进行分析。结果本组发生手术后并发症42例(52.5%),常见并发症为气管软化22例(27.5%)、出血16例(20.0%)、伤口感染8例(10.0%),少见并发症为气管狭窄4例(5.0%)、套管堵塞4例(5.0%)、脱管3例(3.8%),皮下气肿3例(3.8%)、气管食道瘘2例(2.5%)等。并发症相关危险因素有带管时间过长、凝血障碍、糖尿病和阶段使用糖皮质激素。结论老年患者多患有多种全身性疾病,其中气管软化的发生与带管时间过长、出血与凝血障碍、伤口感染与阶段使用糖皮质激素及糖尿病关系密切。气管插管后择期行气管切开术,可以提高手术安全性,减少并发症的发生。

Objective To explore the risk factors and the measures for prevention and treatment of tracheostomy complications in the elderly. Methods A retrospective study of 80 tracheotomies performed during October 1989 to August 2005（aged 80 to 102 years） was presented. The risk factors for the complications were studied with logistic regression analysis. Results Major complications occurred in 42 cases（52. 5 %）. The most common complication was tracheomalacia, which occurred in 22 cases（27.5 %）. Hemorrhage which was the second most common complication occurred in 16 cases （20.0%）. The risk factors were the long-term tracheostomy, coagulation disturbance, diabetes and the use of corticosteroid hormone. Conclusions Long-term tracheostomy is one of the risk factors for tracheomalacia. Bleeding may be associated with coagulation difficulty, Incisional infection may be correlated with abuse of hormone or diabetes. We should perform tracheostomy after tracheal intubation to ensure the operative safety and decrease the odds of the complications.