瘢痕体质患者气管切开术后声门下气管狭窄的发生情况

Occurrence of subglottic tracheal stenosis after tracheotomy in patients with cicatricial diathesis

目的探讨瘢痕体质患者气管切开术后声门下气管狭窄的发生情况。方法选择2012年5月至2017年5月既往在重症监护室行气管切开术、再次入院进行气道治疗的患者。将发生声门下气管狭窄的患者分为瘢痕体质组和非瘢痕体质组。记录狭窄部位样本的病理检测结果;采用Myer-Cotton分级评估声门下气管狭窄程度。记录带套管时间、声门下气管狭窄发生时间,记录治疗效果。结果共纳入气管切开术患者2276例(瘢痕体质患者139例、非瘢痕体质患者2137例),声门下气管狭窄发生率2.90%,瘢痕体质患者声门下气管狭窄发生率明显高于非瘢痕体质患者(P<0.01)。与非瘢痕体质组比较,瘢痕体质组Myer-Cotton分级升高,声门下气管狭窄发生时间缩短,治疗次数增多,治疗有效率降低,瘢痕形成率升高(P<0.01)。结论瘢痕体质患者气管切开术后更易发生声门下气管狭窄,程度严重,治疗效果较差。

Objective To investigate the occurrence of subglottic tracheal stenosis after tracheotomy in the patients with cicatricial diathesis.Methods From May 2012 to May 2017,the tracheotomized patients in intensive care unit who were readmitted for airway therapy were selected.Patients with subglottic tracheal stenosis were assigned to cicatricial diathesis group and non-cicatricial diathesis group.Samples of tracheal stenosis were obtained for routine pathological examination,and the results were recorded.The degree of tracheal stenosis was classified according to the Myer-Cotton grade.The time of bearing a tracheal cannula and time of subglottic trachea stenosis were recorded,and the therapeutic effect was also recorded.Results A total of 2276 racheotomized patients(139 with cicatricial diathesis and 2137 with non-cicatricial diathesis)were included in this study,the incidence of subglottic tracheal stenosis was 2.90%,and the incidence of subglottic tracheal stenosis was significantly higher in patients with cicatricial diathesis than in those with non-cicatricial diathesis(P<0.01).Compared with non-cicatricial diathesis group,the Myer-Cotton grade was significantly increased,the time of subglottic tracheal stenosis occurred was shortened,the treatment times were increased,the rate of effective treatment was decreased,and the scar formation rate was increased in cicatricial diathesis group(P<0.01).Conclusion Patients with cicatricial diathesis are more likely to develop subglottic tracheal stenosis after tracheotomy,with severe degree and poor treatment effect.