气管切开术

气管切开术是一项临床常见的手术操作,偶尔也会在院外实施。手术目的为在颈前气管造口以建立人工气道,使得患者可以自由地通过颈部造口通气,免受窒息的威胁。目前,临床上主要应用于需要进行长期机械通气的患者,特别是重症医学科。随技术和设备的更新换代,临床医生和学者对气管切开术进行了各种尝试,希望能尽可能地降低术中术后并发症。手术向着微创化、多样化发展,手术切口越来越小,手术方法由单一的外科气管切开术,进化出多样的经皮气管切开术、快速反应气管切开术等。不同的手术技巧,其手术的适应症、禁忌症及术中术后出现出血、感染、气肿、声门下狭窄等并发症的发生率也不甚相同。本文重点回顾了气管切开术的历史与现状、颈部解剖生理、适应症、禁忌症和临床常见并发症,并提出对应的预防和解决方法,为临床医生进行手术方案的选择及预防和治疗并发症提供合理新思路,除此之外,我们也基于临床经验提供了一些建议。

Tracheostomy

ABSTRACT: Tracheostomy is a common operation in hospital and sometimes it will be performed out of the hospital. The operation aims at building an artificial airway in the front of the patient''s neck. And then, the patients do not need to suffer from the fear of asphyxia and they can easily breathe fresh air or oxygen transported by the ventilator through the tracheostoma. Currently, tracheostomy is commonly applied to patients who need long-term mechanical ventilation, especially those who have to stay in the Intensive Care Unit for various causes. Along with the development of science technology and upgrading of medical knowledge, clinical doctors and scholars have been doing a lot of effort and trying to advance the tracheostomy techniques to reach the goal of simplifying the procedure and decreasing the incidence of both the intra-operative complications and post-operative complications as much as possible. Furthermore, the surgery tends to minimally invasive and diversify. The incision is much smaller than before and the operation method has already changed from the single surgeon tracheostomy to a variety of operative procedures, such as the popular percutaneous tracheostomy, the brand new rapid response tracheostomy, etc. Compared the operation with one hundred years ago, the incidence of surgical indications, contraindications and complications, such as bleeding, infection and emphysema, subglottic stenosis, have also changed a lot. This article reviews the history and status quo of tracheostomy, and discuss the anatomy and physiology of neck as a focal point, then expatiate on indications, contraindications and complications, such as hemorrhage, emphysema and infection. In order to help clinical doctors to make a perfect selection of surgery and broaden their horizons. We also put forward the corresponding prevention and solution to those situations. In addition, we provide some suggestions based on clinical experience in this paper for the readers to explore.