气管切开术中气管后壁损伤的常见原因及处理措施

Common causes and countermeasures of tracheal posterior wall injury during tracheotomy

目的探讨气管切开术中导致气管后壁损伤的常见原因及应对措施.方法回顾性分析河北医科大学第二医院2022年2月至2024年3月收治的12例气管切开术中气管后壁损伤危重症患者的临床资料,探讨其常见原因及应对措施.结果12例患者经口插管至气管切开留置时间为18~40 d,平均(31.54±4.52)d;于气管切开术前测得的气囊压力为37~54 cmH2O(1 cmH2O≈0.098 kPa),平均(42.34±5.23)cmH2O.经口插管、紧贴气管前壁经造瘘口插管及纤维支气管镜引导下经造瘘口插管这3种应对措施在预防术中出现气管后壁损伤并发症时均发挥了重要作用.2例术后出现伤口出血,给予伤口内凡士林油纱条填塞,出血症状于3d后停止;2例术后出现皮下气肿,且均在5~7 d后自主消失;1例于术后1d胸部CT检查发现气胸,经胸腔闭式引流5d后症状缓解;无因并发症而死亡的患者.结论气管切开术前插管时间过长、气管套囊压力过高是引起术中气管后壁损伤的主要常见原因,3种方法均可在短时间内避免气管后壁损伤并发症的发生,挽救患者生命,其中纤维支气管镜引导下经造瘘口插管的效果更好于另2种措施,可最大程度减少患者术后并发症的发生.

Objective To investigate the common causes and countermeasures of tracheal posterior wall injury during tracheotomy.Methods Clinical data of 12 critically ill patients with posterior tracheal wall injury during tracheotomy admitted to the Second Hospital of Hebei Medical University from February 2022 to March 2024 were retrospectively analyzed,and the common causes and countermeasures were discussed.Results A total of 12 patients were intubated through the mouth to tracheostomy for 18-40 days,with an average of(31.54±4.52)days;the pressure of the cuff before tracheostomy was measured as 37-54 cmH2O(1 cmH2O≈0.098 kPa),with an average of(42.34±5.23)cmH2O.The 3 clinical countermeasures oral intubation,anastomotic intubation close to the anterior tracheal wall and fiberbronchoscope-guided intubation played an important role in the occurrence of intraoperative complications.Wound bleeding occurred in 2 patients after operation,vaseline gauze was given to fill the wound,and the bleeding symptoms stopped after 3 days.Subcutaneous emphysema occurred in 2 patients after operation,and all of them disappeared spontaneously after 5-7 days.Pneumothorax was found in 1 case by CT examination 1 day after operation,and the symptoms were relieved 5 days later by closed thoracic drainage,and no patient died from this complication.Conclusions Excessive intubation time before tracheotomy and excessive tracheal cuff pressure are the main common causes of intraoperative injury to the posterior tracheal wall.Three clinical countermeasures can solve these complications in a short time and save patients'lives.Compared with the other two measures,fiberbronchoscope-guided intubation can minimize the occurrence of postoperative complications in patients.