长期机械通气并发气管内肉芽的处理策略

杨弋; 王利一; 张雷; 王晓云; 宋海涛; 黄魏宁

doi:10.13201/j.issn.1001-1781.2018.11.014

长期机械通气并发气管内肉芽的处理策略

- 北京医院国家老年医学中心耳鼻咽喉科(北京, 100730)

详细信息

通讯作者: 王利一,E-mail:wangliyi7319@sina.com

中图分类号: R768

收稿日期: 2018-03-28

Management strategies of granulation in tracheal post-tracheostomy caused by prolonged mechanical ventilation

- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China

More Information

Corresponding author: WANG Liyi, E-mail: wangliyi7319@sina.com

Received Date: 28 March 2018

摘要

摘要: 目的：探讨采取不同方法治疗气管切开后长期机械通气并发气管内肉芽的老年患者的疗效及安全性。方法：216例>70岁的老年患者中有44例（20.4%）气管内肉芽形成，肉芽形成时间在气管切开术后2~25个月，平均（14.0±3.2）个月。其中Ⅰ度12例，Ⅱ度18例，Ⅲ度14例。Ⅰ~Ⅱ度（共30例）患者予以更换可调节气管套管；14例Ⅲ度患者气管肉芽组织增生，行钬激光切除。结果：44例老年患者治疗过程顺利，未发生气道穿孔、出血不止及窒息等并发症。术后症状完全消失，内镜检查可见气道通畅。随访无复发。结论：更换可调节气管套管和钬激光可安全、有效地治疗气管切开术后气管内肉芽组织增生所致的气道梗阻。
- 气管切开术 /
- 气道狭窄 /
- 钬激光 /
- 气管套管 /
- 肉芽组织
Abstract: Objective: To analyze the effect and safety of treatment in patients with airway stenosis caused by tracheotomy for mechanical ventilation.Method: We treated the patients with airway stenosis caused by granulation tissue. The patients with grade Ⅰ,Ⅱ airway stenosis were treated with adjustable flange tracheostomy tube, and the holmium laser under a fibro-laryngoscope were applied for the patients with grade Ⅲ airway stenosis. Two hundred and sixteen patients were enrolled in this study. Forty-four patients had been found tracheal stenosis caused by granulomatous hyperplasia, accounting for 20.4% of all patients, including 12 cases of gradeⅠ, 18 cases of grade Ⅱ, and 14 cases of grade Ⅲ. Result: Thirty patients with grade Ⅰ and Ⅱ were replaced with adjustable flange tracheostomy cannula. Fourteen cases of grade Ⅲ airway stenosis were treated with Ho:YAG laser under a fibro laryngoscope. All cases were completed operation successfully. None of cases bleeding, perforated and asphyxia during operation. The clinical symptoms disappeared after operation, and endoscopy showed that airways of patients were smooth. No recurrence were found after operation.Conclusion: Replacement of adjustable flange tracheostomy tube and Ho:YAG laser can safely and effectively treat airway obstruction caused by tracheal granulation tissue hyperplasia after tracheotomy.
- tracheotomy /
- airway stenosis /
- holmium laser /
- tracheal cannula /
- granulation tissue

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