Heffner J E
Medical University of South Carolina, Division of Pulmonary and Critical Care Medicine, Allergy, and Clinical Immunology, Charleston, SC, USA.
Chest. 2001 Dec;120(6 Suppl):477S-81S. doi: 10.1378/chest.120.6_suppl.477s.
Tracheotomy is commonly performed in ventilator-dependent patients. Disadvantages to the procedure are perioperative complications, long-term airway injury, and the cost of the procedure. Benefits ascribed to tracheotomy vs prolonged translaryngeal intubation include improved patient comfort, more effective airway suctioning, decreased airway resistance, enhanced patient mobility, increased potential for speech, ability to eat orally, a more secure airway, accelerated ventilator weaning, reduced ventilator-associated pneumonia, and the ability to transfer ventilator-dependent patients from the ICU. None of these benefits, however, have been demonstrated in large-scale, prospective, randomized studies. It is proposed that there should be an anticipatory approach wherein tracheotomy is considered after an initial period of stabilization with the patient receiving mechanical ventilation when it becomes apparent that the patient will require prolonged ventilator assistance. Tracheotomy then is performed when the patient appears likely to gain one or more of the benefits ascribed to the procedure.
气管切开术常用于依赖呼吸机的患者。该手术的缺点包括围手术期并发症、长期气道损伤以及手术费用。气管切开术与延长经喉插管相比的益处包括提高患者舒适度、更有效的气道吸引、降低气道阻力、增强患者活动能力、增加言语可能性、能够经口进食、气道更安全、加速撤机、减少呼吸机相关性肺炎以及将依赖呼吸机的患者从重症监护病房转出的能力。然而，这些益处均未在大规模、前瞻性、随机研究中得到证实。有人提出应采取一种前瞻性方法，即在患者接受机械通气初始稳定期后，当明显看出患者需要长期呼吸机辅助时考虑气管切开术。当患者似乎有可能获得该手术带来的一项或多项益处时，再进行气管切开术。
