改良气管切开术在困难气管切开患者中的临床应用

Clinical application of modified tracheostomy in patients with difficult tracheostomy

目的 分析困难气管切开的原因,探讨技术改进措施,提高气管切开成功率.方法 回顾性分析2016年8月至2017年2月河南省人民医院收治的48例采用改进困难气管切开术的困难气管切开患者的临床资料,分析并探讨造成患者气管切开困难的原因.统计采用改进的困难气管切开术的手术时间、出血量、并发症发生情况及成功率等.结果 48例困难气管切开患者均成功实施气管切开术.手术时间8～41 min,出血量4～25 ml.术后出血3例,无一例发生气管食管瘘.结论 困难气管切开的技术改进可有效行气管切开,具有创伤小、出血少、损伤小、操作时间短、术后切口瘢痕小等优点.

Objective To summarize and analyze the causes of difficult tracheotomy, investigate the technical improvement measures, and to improve the success rate of tracheotomy. Methods The clinical data of 48 patients with difficult tracheostomy and treated by modified tracheostomy in Henan Provincial People＇s Hospital, from August 2016 to February 2017, were retrospectively analyzed. The causes of difficult tracheostomy were analyzed and discussed. The operation time, bleeding volume, incidence of complications and success rate of modified difficult tracheotomy were statistically analyzed. Results Tracheostomy was successfully performed in 48 patients with difficult tracheotomy. The operation time was 8 to 41 minutes, and the amount of bleeding was 4 to 25 ml. Postoperative bleeding was found in 3 cases. There was no patient with tracheoesophageal fistula after treatment. Conclusions The technical improvement of difficult tracheotomy effectively resolve difficult tracheotomy, it has advantages of less trauma, less bleeding, less injury, shorter operation time and smaller scar after operation.