硅酮支架治疗气管插管或切开后气道狭窄的疗效观察

Curative effect of silicone stents on the treatment of airway stenosis after tracheal intubation or tracheotomy

目的评价硅酮支架治疗气管插管或切开后气道狭窄的疗效和安全性。方法本研究为非随机对照试验。采用非随机抽样的方法纳入2020年3月至2023年3月在应急总医院呼吸与危重症医学科收治的69例由气管插管或切开导致气道狭窄的患者。根据是否接受气道硅酮支架治疗将其分为支架组(23例)和对照组(46例),对照组接受常规气管镜下球囊扩张和冷冻治疗。比较2组患者治疗前的临床资料(性别、年龄、狭窄距声门距离、气道狭窄长度、治疗前改良英国医学研究委员会呼吸困难量表(mMRC)评分和治疗前气道狭窄程度),以及治疗后1个月和3个月的mMRC评分、气道狭窄程度、气管镜治疗间隔时间、1年内治疗有效率和严重不良反应发生率,并对支架组治疗后的并发症进行分析。结果2组患者性别、年龄、狭窄距声门距离、气道狭窄长度、治疗前mMRC评分和治疗前气道狭窄程度比较差异均无统计学意义(均P>0.05)。治疗后1个月和3个月,支架组的mMRC评分和气道狭窄程度均优于对照组(治疗后1个月mMRC评分:平均秩分别为23.36、39.83,Z=3.39,P=0.001;治疗后3个月mMRC评分:平均秩分别为25.41、38.85,Z=2.95,P=0.003;治疗后1个月气道狭窄程度:平均秩分别为15.82、43.43,Z=5.68,P<0.001;治疗后3个月气道狭窄程度:平均秩分别为18.36、42.22,Z=4.95,P<0.001)。支架组气管镜治疗间隔时间长于对照组,差异有统计学意义[(46.6±33.3)d比(14.4±9.1)d,t=6.17,P<0.001]。对照组和支架组1年内治疗有效率和严重不良反应发生率比较差异均无统计学意义[95.7%(44/46)比82.6%(19/23),4.3%(2/46)比0(0/23),均P>0.05]。支架组治疗后的并发症主要为分泌物潴留和肉芽组织增生,多为轻度,不需额外治疗,相比于对照组未见明显严重不良反应。结论硅酮支架治疗气管插管或切开后气道狭窄有效、安全、经济,能减少内镜治疗次数,改善呼吸困难,提高生活质量。

ObjectiveTo evaluate the efficacy and safety of silicone stents on the treatment of airway stenosis after tracheal intubation or tracheotomy.MethodsIt was a non-randomized controlled trial.Sixty-nine patients with airway stenosis caused by tracheal intubation or tracheotomy who were admitted to the Department of Respiratory and Critical Care Medicine of Emergency General Hospital from March 2020 to March 2023 were enrolled by the non-random sampling method.According to the use of silicone stents or not,they were divided into stent group(23 cases)and control group(46 cases).Patients in the control group were treated with endobronchial cryotherapy in conjunction with balloon dilation.The clinical data before treatment(gender,age,distance from airway stenosis to glottis,length of airway stenosis,the modified Medical Research Council[mMRC]Dyspnoea Scale score,degree of airway stenosis),and mMRC Dyspnoea Scale score,degree of airway stenosis,interval of bronchoscopy at 1 month and 3 months after treatment,1-year effective rate and incidence of severe adverse events were compared between groups.Complications in the stent group were analyzed.ResultsThere were no significant differences in gender,age,distance from stenosis to glottis,length and degree of airway stenosis and the mMRC Dyspnoea Scale score before treatment between the two groups(all P>0.05).At 1 month and 3 months after treatment,the mMRC Dyspnoea Scale score(1 month:23.36 vs 39.83,Z=3.39,P=0.001;3 months:25.41 vs 38.85,Z=2.95,P=0.003)and degree of airway stenosis(1 month:15.82 vs 43.43,Z=5.68,P<0.001;3 months:18.36 vs 42.22,Z=4.95,P<0.001)were significantly improved in the stent group than those of control group.The interval of bronchoscopy in the stent group was significantly longer than that of control group([46.6±33.3]d vs[14.4±9.1]d,t=6.17,P<0.001).There were no significant differences in the 1-year effective rate(95.7%[44/46]vs 82.6%[19/23],P>0.05)and incidence of severe adverse events(4.3%[2/46]vs 0[0/23],P>0.05)between the control group and the stent group.Complications after stent treatment were mainly secretion retention and granulation tissue hyperplasia,which were mostly mild without an additional treatment.Obvious serious adverse events were not found in the stent group compared with those of the control group.ConclusionsSilicone stent treatment of airway stenosis after tracheal intubation or tracheotomy is effective,safe and economical,which can reduce the times of endoscopic treatments,alleviate dyspnea,and improve the quality of life.