气管切开后拔管困难原因分析及处理

Cause and treatment in difficult decannulation of tracheotomy patients

摘要:

目的??探讨可弯曲支气管镜（纤维支气管镜/电子支气管镜，简称支气管镜）在气管切开术后拔管困难诊治中的意义。方法?回顾性分析17例经可弯曲支气管镜检查确诊和治疗的气管切开术后拔管困难患者的临床资料。结果?17例拔管困难患者，除1例脑外伤气管上端瘢痕挛缩伴闭锁拔管失败外；其余16例患者均成功拔管，拔管成功率94.1%。除1例患者出现支架移位、1例患者拔管后出现呼吸困难外，余无不良事件发生，无致死性并发症发生。结论?可弯曲支气管镜在气管切开术后拔管困难患者诊治中起着重要作用，且安全可靠，值得临床推广。

Abstract:

Objective?To observe the value of flexible bronchoscopy (fiberoptic bronchoscopy/electronic bron choscopy, abbreviation bronchoscopy) in the diagnosis and treatment of patients with decannulation difficult after tracheotomy.?Methods?17 cases with decannulation difficult after tracheotomy which were diagnosed and treated by flexible bronchoscopy were reviewed and evaluated.?Result?Among the 17 patients with decannulation difficult, except one failure in decannulation because of upper airway scar contracture with atresia after brain injury, the rest was successful, and decannulation rate was 94.1%. Except one patient with displacement of metal stents, and one patient with breathing difficulty after the decannulation, there was no other adverse reactions and deadly complications.?Conclusion?Flexible bronchoscope plays an important part in the diagnosis and treatment of the patients with decannulation difficult after tracheotomy. It is safe and reliable, so it is worthy of clinical promotion.