CAJ | 학술논문

目的探讨儿童与成人气管切开术后致拔管困难的病因、诊断、治疗以及提高拔管成功率的方法.方法回顾性分析1990年1月至2006年10月我院收治的56例气管切开术后致拔管困难患者的临床资料.其中儿童组24例,年龄14个月～14岁,气管切开术后时间6个月～2年；成人组32例,年龄15～48岁,气管切开术后6个月～1.5年.结果儿童与成人气管切开术后致拔管困难主要病因、诊断方法的选择及治疗过程中的特点、表现均存在不同.儿童气管切开术后致拔管困难主要发生在喉炎、气道异物致气道阻塞抢救性气管切开术后(14/24,58.33％),其次为头颈部外伤等急诊气管切开术(7/24,29.17％).成人气管切开术后拔管困难主要发生在喉部外伤所致的喉部病变(包括喉畸形、声门下狭窄或声带麻痹)(23/32,71.88％).儿童患者抗炎治疗组的平均堵管时间明显低于未抗炎治疗患者组(6.2d vs 10.1 d,t=4.26,P＜0.01).而成人患者抗炎治疗组与未抗炎治疗组的平均堵管时间比较差异无统计学意义(t=1.63,P＞0.05).在治疗过程中,儿童出现自觉呼吸困难的比率(21/21,100％)也明显高于成人组(13/28,46.43％).结论 3岁以下儿童应尽量避免气管切开术,3岁以上患儿气管切开术后能否成功拔管与年龄无确切相关.儿童患者首次治疗失败可能与炎症的存在有关；在治疗过程中应注意自觉呼吸困难发生的特点,儿童患者应选择无创性检查方法.重视心理因素对患者尤其是儿童的影响.
목적 탐토인동여성인기관절개술후치발관곤난적병인、진단、치료이급제고발관성공솔적방법.방법 회고성분석1990년1월지2006년10월아원수치적56례기관절개술후치발관곤난환자적림상자료.기중인동조24례,년령14개월～14세,기관절개술후시간6개월～2년；성인조32례,년령15～48세,기관절개술후6개월～1.5년.결과 인동여성인기관절개술후치발관곤난주요병인、진단방법적선택급치료과정중적특점、표현균존재불동.인동기관절개술후치발관곤난주요발생재후염、기도이물치기도조새창구성기관절개술후(14/24,58.33％),기차위두경부외상등급진기관절개술(7/24,29.17％).성인기관절개술후발관곤난주요발생재후부외상소치적후부병변(포괄후기형、성문하협착혹성대마비)(23/32,71.88％).인동환자항염치료조적평균도관시간명현저우미항염치료환자조(6.2d vs 10.1 d,t=4.26,P＜0.01).이성인환자항염치료조여미항염치료조적평균도관시간비교차이무통계학의의(t=1.63,P＞0.05).재치료과정중,인동출현자각호흡곤난적비솔(21/21,100％)야명현고우성인조(13/28,46.43％).결론 3세이하인동응진량피면기관절개술,3세이상환인기관절개술후능부성공발관여년령무학절상관.인동환자수차치료실패가능여염증적존재유관；재치료과정중응주의자각호흡곤난발생적특점,인동환자응선택무창성검사방법.중시심리인소대환자우기시인동적영향.
Objective To investigate the causes,diagnosis,treatment of the difficult postoperative decannulation resulting from tracheotomy between children and adults and the method of improving the rate of successful decannulation.Methods Clinical data of 56 cases with difficult decannulation after tracheotomy were analysed retrospectively,all the patients were admitted in our hospital between Jan 1990 and Oct 2006.All the patients were separated into two groups,children group including 24 cases of 14 months ～ 14 years old,adult group including 32 cases of age ranging 15 ～ 48 years old.The postoperative time after tracheotomy were 6 month ～ 1.5 year and 6 month ～ 2 year respectively.Results There were differences of the etiology,diagnostic choice and the clinical manifestation in the treatment of the diffficult decannulation after tracheotomy between children and adults.Children with difficult decannulation after tracheotomy occurred mainly in laryngitis and airway foreign body airway caused by obstruction retrieved after tracheotomy (14/24,58.33 ％),followed by the emergency tracheotomy,such as head and neck trauma (7/24,29.17％).Adults with difficult decannulation after tracheotomy mainly occurred in the throat caused by traumatic lesions of the larynx (including malformations,subglottic stenosis of larynx or vocal cord paralysis) (23/32,71.88％).The average block time in children with anti-inflammatory treatment was significantly lower than that in without anti-inflammatory therapy (6.2 d vs 10.1 d,t =4.26,P ＜ 0.01).However,there was no significant difference in the average block time in adults with anti-inflammatory and without anti-inflammatory treatment (t =1.63,P ＞ 0.05).In the course of treatment,rates of children consciously breathing difficulties (21/21,100％) was also significantly higher than the adult group (13/28,46.43％).Conclusion Children less than 3 years old should avoid tracheotomy.There is no definite relation between the successful treatment in the difficult decannulation and the age of the patients over 3 years old.The first failure treatment in children may be related with the local inflammation.When in treatment,doctors should observe the characteristics of respiratory difficulties,take attention to the influence of children psychological factors to the treatment.Children should be treated in the non-traumatic examination methods.