吸入性损伤气管切开术后并发气管食管瘘的危险因素及防治

The risk factors and treatments of tracheoesophageal fistula after tracheotomy in inhalation injury patients

目的探讨严重烧伤伴吸入性损伤患者气管切开术后发生气管食管瘘的危险因素及防治方法。方法回顾分析4例患者气管切开术后发生气管食管瘘的临床资料。结果4例患者气管食管瘘全部愈合,2例患者最终痊愈,2例患者死于后期并发合并症。结论气管黏膜本身的损伤是吸入性损伤患者发生气管食管瘘的基础和主要原因。防止误吸、减少对气管的机械性刺激、及时而充分的气道湿化、气管套管定时清洁消毒及更换、防治肺部感染,是气管切开术后处理气管食管瘘的有效措施。

Objective To explore the risk factors and treatments of tracheoesophageal fistula after tracheotomy in severe burn patients complicated with inhalation injury. Methods The clinical data of tracheoesophageal fistula after tracheotomy in four burn patients complicated with inhalation injury were summarized. Results By these measures, all the 4 cases of tracheoesophageal fistula were cured. And 2 cases survived and the others died of late complications at last. Conclusions The injury of airway itself caused by inhalation is the key reason for the tracheoesophageal fistula. To prevent inbalational pneumonia, reduce the mechanical stimulation to the trachea, moist and drain the airway on time and treat the infection of lung are the effective measures to treat tracheoesophageal fistula after tracheotomy.