脑损伤气管切开患者气道狭窄致拔管困难原因分析及治疗对策

目的 探讨脑损伤气管切开患者气道狭窄致拔管困难原因及治疗对策.方法 收取2015年1月至2016年10月70例脑损伤气管切开拔除气管套管困难患者.气管切开后时间为2-6个月.70例拔管困难患者均予支气管镜和颈部气道CT检查明确拔管困难原因,并及时针对原因进行治疗.结果 经支气管镜和颈部气道CT检查70例拔管困难患者均有气道狭窄.经支气管镜检查：有18例患者有咽部气道黏膜水肿和充血,34例患者气管和支气管黏膜充血、出血、糜烂或有疤痕形成.颈部气道CT检查：有18例患者气管内有肉芽组织生长,有10例患者有套管位置偏移,15例患者气管套管内形成痰痂,8例患者有气管软骨软化.上述原因均可引起气道狭窄致拔管困难.及时针对引起气道狭窄的病因进行治疗,治疗后70例患者有65例成功拔除气管套管.结论 脑损伤气管套管拔管困难的常见原因是气道狭窄,针对气道狭窄早期的预防和及时治疗可以提高拔管的成功率,临床主要检查方法为支气管镜和颈部气道CT.

Objective To explore difficulties and treatment strategies to difficult decannulation caused by airway stenosis of patients with brain injury and tracheotomy. Methods 70 patients with brain injury and tracheotomy were collected from January 2015 to October 2016.The time after tracheotomy was 2 to 6 months. 70 patients with difficulty in tracheotomy were all given bronchoscope and neck airway CT examination to identify causes of difficult decannulation and make treatment against causes. Results Such 70 patients all had airway stenosis. By bronchoscope examination：18 patients had pharyngeal airway mucosa edema and hyperemia. 34 patients had trachea and bronchial mucosa hyperemia,bleeding,erosion or scar formation. Neck airway CT examination：18 patients had granulation tissue in trachea. 10 patients had offset cannula portals placement. 15 patients formed sputum scab in trachea cannula portals. 8 patients had tracheal chondromalacia. The above causes could cause difficult decannulation resulted from airway stenosis. Treat causes of airway stenosis. After the treatment,65 among 70 patients succeed in eliminating trachea cannula portals. Conclusion The common reason of difficult decannulation caused by airway stenosis of patients with brain injury and tracheotomy is airway stenosis. Earlier and timely treatment against airway stenosis can promote success rate. The main clinical examination methods are bronchoscope and neck airway CT.