气管插管致气管狭窄患者介入治疗失败原因初探

A preliminary study on the failure reasons of interventional therapy for tracheal stenosis caused by tracheal intubation

目的初步探讨气管插管导致的气管狭窄患者行介入治疗失败的原因。方法对气管插管术后气管狭窄行纤支镜介入治疗的24例患者,根据治疗结果分为介入治疗有效组和失败组,其中有效组患者20例,失败组患者4例。对两组患者的临床资料进行回顾性分析。结果介入治疗失败组患者肺泡灌洗液或痰培养阳率(50.0%)显著高于有效组(0.0%),插管次数明显多于有效组,差异有统计学意义(P<0.05或P<0.01)。介入治疗失败组患者纤支镜下气管狭窄段均可见多个狭窄环,充血明显,并且均存在不同程度的软骨软化。CT检查显示,介入治疗失败组患者气管狭窄平均长度大于有效组患者,气管壁软骨环断裂发生率、钙化率均高于有效组患者,差异有统计学意义(P<0.01);介入治疗失败组患者膜部、右侧后夹角厚度均大于有效组,差异有统计学意义(均P<0.01)。结论影响气管插管后狭窄患者纤支镜介入治疗效果的因素较多,主要与患者基础病的严重程度以及气管损伤的严重程度有关。对频繁气管插管造成的气管狭窄膜部增厚、气管软骨断裂及气管壁钙化的气管狭窄患者,不宜选择介入治疗,而应选择外科手术治疗。

Objective To discuss the failure reasons of interventional therapy for tracheal stenosis caused by tracheal intubation. Methods 24 patients with tracheal stenosis after tracheal intubation were treated with fiberoptic bronchoscope,which were divided into the effective group and the failure group according to the results of the treatment. There were 20 patients in the effective group and 4 in the failure group. The clinical data of two groups of patients were analyzed retrospectively. Results The sputum culture positive rate（50%） of the alveolar lavage fluid in the failure group was significantly higher than that in the effective group（0%）. The number of intubation was significantly more than that of the effective group,and the difference was statistically significant（ P〈0. 05 or 0. 01）. A number of narrow rings were found in the stenosis segment of the trachea under fiberoptic bronchoscopy in the failure group,whose hyperemia was obvious,and there were varying degrees of chondrosoftening. The CT examination showed that,The average length of tracheal stenosis in the failure group was longer than that of the effective group. The incidence of rupture of the tracheal wall cartilage ring and the rate of calcification were higher than those in the effective group,the difference was statistically significant（ P〈0. 01）. The thickness of the membrane and right posterior angle of the patients in the failure group were all bigger than those in the effective group,and the difference was statistically significant（ P〈0. 01）.Conclusion There are many factors affecting the effect of bronchoscopic interventional therapy for patients with tracheal intubation.It is mainly related to the severity of the patient＇s basic disease and the severity of the injury of the trachea. For patients with tracheal stenosis caused by frequent tracheal intubation,tracheal stenosis,thickening of membrane,tracheal cartilage rupture and tracheal calcification,surgical intervention is not appropriate to choose interventional therapy,but surgical treatment should be selected.