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国际呼吸杂志

创刊年:1981年

刊   期:半月刊

主   编:阎锡新

主   任:张雷

地   址:石家庄市中山东路361号

邮   编:050017

电   话:0311-86266873

E- mail:guojihuxi@vip.163.com

网   址:www.guojihuxi.com

邮发 代号:18-12

中国连续出版物号:ISSN 1673-436X

CN 13-1368/R

2017 年   第 37 卷   第 8 期   半月刊

207例气管切开/气管插管后良性气道狭窄的疗效分析

王洪武 张楠 周云芝 李冬妹 邹珩 张洁莉

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  [摘要] 目的:本文旨在分析良性气道狭窄气管切开/气管插管后发生再狭窄采用球囊导管扩张加冷冻等综合治疗措施的疗效及安全性。 方法:回顾性分析2005.8~2014.12住煤炭总医院的207例良性气道再狭窄患者,其中气管插管83例,气管切开124例。采用球囊导管扩张、CO2冷冻等综合治疗方法。 结果: 83例气管插管置管时间为12.7±1.3天, 拔管后30.3±4.1天发生再狭窄。124例气管切开患者分别为100.0±23.8天和73.2±12.8天。插管组累及气管1区(86.0%),切开组累及气管1区和2区分别为68.7%、47.8%。插管组以瘢痕为主(57.1%), 而切开组以肉芽为主(48.1%)。插管组的形态以圆形为主(84.2%),不规则形占14.0%, 而切开组分别为54.8%和40.9%,还有4例(3.5%)完全闭塞。插管组的治疗次数为7.0±0.8次,治愈时间为3.2±0.4月,治愈率为73.3%; 切开组分别为6.7±0.5次,3.3±0.4月和25.0%。硬质镜在切开组比插管组使用率高。冷冻在两组中使用频率最高,分别达56.9%和49.9%, 球囊扩张在插管组使用率达(47.2%)。 结论: 气管镜介入治疗在气管切开/气管插管后再狭窄的治疗中可发挥重要作用,冷冻和球囊导管扩张治疗是两种重要的治疗方法。

  [Abstract] Objective: To analysis the efficacy and the safety of the combined bronchoscopic interventional therapies, including balloon dilatation and cryotherapy ect. in the treatment of post tracheostomy or post intubation benign tracheal stenosis. Methods: 207 cases with benign tracheal stenosis of 83 postintubation and 124 post-tracheostomy were retrospectively analysed in our hospital from Aug 2005 to Dec 2014. All of the patients underwent the combined interventional therapies, including balloon dilatation and cryotherapy ect. Results: The duration of intubation was 12.7±1.3d,then tracheal stenosis was developed in 73.2±12.8 d after tube drawing in 83 cases with post intubation stenosis. But they were 100.0±23.8d and 30.3±4.1d respectively in 124 cases of post tracheostomy.The tracheal stenosis located in the first part of the trachea in 86.0% of post intubation cases.In 68.7% of post tracheostomy cases, the stenosis located in the first part and in 47.8% of cases located the second part.The shape of tracheal stenosis were circular (84.2%) and irregular(14.0%) in the intubation cases .And there were 54.8% and 40.9% respectively in the tracheostomy cases ,in addition of 4 cases(3.5%) were tracheal occlusion.Compared to the two groups,in post intubation cases,the treatment times, cured time and cure rate were 7.0±0.8, 3.2±0.4m, 73.3%respectively,but were 6.7±0.5,3.3±0.4m and 25.0% in post tracheostomy cases.Rigid bronchoscopy was performed more frequently in post tracheostomy cases.The frequency of cryotherapy was highest in all kinds of the interventional therapies,and balloon dilatation was second only to cryotherapy. Conclusions:Bronchoscopic interventional treatments can play an important role in the treatment of post intubation or post tracheostomy stenosis. Both cryotherapy and balloon dilatation are the most important treatment ways.

  [关键词] 良性气管狭窄 气管切开狭窄 气管插管后狭窄 气管镜介入治疗

  [Key words] benign tracheal stenosis;post intubation tracheal stenosis;post tracheostomy tracheal stenosis;bronchoscopic interventional therapy

  [中图分类号]

  [DOI]

  [基金项目]

  [作者简介]

  [作者单位] 煤炭总医院呼吸科

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