气管切开术后气管狭窄的临床特点及相关危险因素分析

Analysis of clinical features of tracheal stenosis after tracheostomy and its' related risk factors

目的 探讨气管切开术后患者发生气管狭窄的临床特征及其相关危险因素.方法 选取2016年1月-2021年12月云浮市云城区两所大型公立医院收治的行气管切开术的患者122例为研究对象,以术后气管狭窄与否将其分为观察组(术后发生气管狭窄,n=37)和对照组(术后未发生气管狭窄,n=85),观察气管狭窄患者的临床特征,采用单因素及多因素Logistic回归法分析其发生气管狭窄的相关危险因素.结果 37例气管狭窄患者中,声门下狭窄23例(62.16%),狭窄程度Ⅲ度22例(59.46%),狭窄长度1.0-3.0cm25例(67.57%),炎性肉芽性狭窄23例(62.16%).通过单因素及多因素Logistic回归分析发现切口位置过高(χ^(2)=4.67,P<0.05),手术操作不当(χ^(2)=5.11,P<0.05),术后反复气道感染(χ^(2)=18.32,P<0.05)及术后机械通气时间长(χ^(2)=21.49,P<0.05)是气管切开术后发生气管狭窄的独立危险因素.结论 气管切开术后发生气管狭窄是多因素共同作用而致,临床上应根据患者疾病特征制定个体化治疗及护理策略,避免危险因素的影响,降低气管狭窄的发生率.

Objective To explore the clinical features of tracheal stenosis and its'risk factors in patients after tracheostomy.Methods From January 2016 to December 2021,122 patients undergoing tracheostomy admitted to two large public hospitals in our region were selected as research objects,and they were divided into observation groups(postoperative tracheal stenosis,according to whether they were postoperatively stenosis or not n=37)and the control group(no postoperative tracheal stenosis,n=85),the clinical characteristics of patients with tracheal stenosis were observed,and the risk factors associated with the development of tracheal stenosis were analyzed by univariate and multivariate logistic regression.Results Among the 37 patients with tracheal stenosis,there were 23 cases(62.16%)of subglottic stenosis,22 cases(59.46%)of stenosis degree II,25 cases(67.57%)of stenosis length of 1.0-3.0cm,and 23 cases(62.16%)of inflammatory granulation stenosis.Univariate and multivariate Logistic regression analysis showed that the incision position was too high(x^(2)=4.67,P<0.05),and the surgical operation was improper(x^(2)=5.11,P<0.05),postoperative recurrent airway infection(x^(2)=18.32,P<0.05)and postoperative mechanical ventilation time(x^(2)=21.49,P<0.05)is an independent risk factor for the development of tracheal stenosis after tracheostomy.Conclus ions The occurrence of tracheal stenosis after tracheostomy is caused by the joint action of multiple factors,and clinically individualized treatment and nursing strategies should be formulated according to the characteristics of the patient's disease,so as to avoid the influence of risk factors and reduce the incidence of tracheal stenosis.