CAJ | 학술논문

目的：探讨颈脊髓损伤患者气管切开术后拔管指征及延迟、失败的原因。方法对我科收治的63例气管切开颈脊髓损伤患者的临床资料进行回顾，采用自行制定的拔管指征指导选择拔管时机，并分析拔管延迟和失败的原因。结果患者氧合情况、咳痰能力及吞咽能力恢复正常，肺部感染控制，喉镜和支气管镜检查提示无喉头水肿，套管远端无明显气道狭窄，视为拔管指征。54例（85.7%）在伤后3个月内一次性拔管成功，拔管距气管切开时间平均43.2 d。7例拔管延迟，原因包括反复肺部感染3例，气管套管远端肉芽组织增生2例，颈前路手术后喉返神经损伤致饮水呛咳及心理因素各1例。2例拔管失败，其中1例重新插管最终带管出院，另1例因急性呼吸衰竭死亡。结论本研究制定的拔管指征可较安全的指导颈脊髓损伤患者气管切开术后选择拔管时机。反复肺部感染是导致拔管延迟和失败的主要原因。拔管后气管软化塌陷发生率虽较低，但危害大，应引起重视。
목적：탐토경척수손상환자기관절개술후발관지정급연지、실패적원인。방법대아과수치적63례기관절개경척수손상환자적림상자료진행회고，채용자행제정적발관지정지도선택발관시궤，병분석발관연지화실패적원인。결과환자양합정황、해담능력급탄인능력회복정상，폐부감염공제，후경화지기관경검사제시무후두수종，투관원단무명현기도협착，시위발관지정。54례（85.7%）재상후3개월내일차성발관성공，발관거기관절개시간평균43.2 d。7례발관연지，원인포괄반복폐부감염3례，기관투관원단육아조직증생2례，경전로수술후후반신경손상치음수창해급심리인소각1례。2례발관실패，기중1례중신삽관최종대관출원，령1례인급성호흡쇠갈사망。결론본연구제정적발관지정가교안전적지도경척수손상환자기관절개술후선택발관시궤。반복폐부감염시도치발관연지화실패적주요원인。발관후기관연화탑함발생솔수교저，단위해대，응인기중시。
Objective To investigate the indications,delay and failure causes of decannulation after tracheostomy in treatment of cervical spinal cord injury. Methods Clinical data of 63 patients with cervical spinal cord injury after tracheosto-my was reviewed,and self-designed indications guidance for decannulation was used to choose the time of removing tubes. The delay and failure causes of decannulation were analyzed. Results The patients′oxygenation,expectoration and swallowing a-bilities were recoveried,the pulmonary infection was controlled,and there were no laryngeal edema by laryngoscope and bron-choscopes examinations and no obvious airway constriction in distal cannula. All above conditions were used as decannulation indications. Fifty four patients(85. 7%)underwent removal surgery of the tracheostomy tubes successfully within 3 months af-ter injury. The mean interval between incision of tracheal and decannulation was 43. 2 d. Seven patients(11%)had delayed decannulation,and the causes including repeated pulmonary infection in 3 patients,granulation tissue hyperplasia in distal tra-cheostomy tube in 2 patients,drinking bucking induced by recurrent laryngeal nerve injury after anterior cervical fusion in 1 patient and psychologic factor in 1 patient. Decannulation failure occurred in 2 patients and one received tracheostomy again and was discharged with the tracheostomy tubes,the other one died of acute respiratory failure. Conclusion Self-designed indication for decannulation may guide the time of removing the tracheostomy tubes safely for patients with cervical spinal cord injury after tracheostomy. Repeated pulmonary infection is the main cause of delayed and failed decannulation. Incidence rates of tracheal stenosis and tracheomalacia are low,but the complications may be life threatening,which should be given much more attention.