Corbett Harriet J, Mann Kulbir S, Mitra Indu, Jesudason Edwin C, Losty Paul D, Clarke Raymond W
Division of Child Health, The Royal Liverpool Children's Hospital, University of Liverpool, Eaton Road, Liverpool, L12 2AP, UK.
J Pediatr Surg. 2007 Jul;42(7):1251-4. doi: 10.1016/j.jpedsurg.2007.02.017.
BACKGROUND/PURPOSE: Tracheostomy in the pediatric population is associated with significant morbidity and mortality compared to adult practice. This study highlights evolving experience from a UK children's hospital.
All children undergoing tracheostomy between 1995 and 2004 were identified. Indications, complications, and outcomes were evaluated.
Complete case records were reviewed for 112 children (age range, newborn-18 years). Indications included congenital birth defects--craniofacial disorders, esophageal atresia, laryngeal cleft, cystic hygroma, vascular malformations. Acquired upper airway pathology (15.5%) and malacia (12.1%) were additional criteria. Tracheostomy was also required for long-term ventilation in patients with neuromuscular disorders (12.1%) or ventilator dependency (26.7 %). Fifty-eight (50%) tracheostomies were created in infants <1 year. One hundred and nine were elective procedures with only 7 (6%) for emergency airway management. Morbidity included wound problems (14, 14.4%), tube displacement or obstruction (14, 14.4%), tracheocutaneous fistula (6, 6.2%), and pneumothorax (4, 4.1%). There were no acute hemorrhagic complications. Two children died after accidental tube displacement/obstruction.
Tracheostomy at this UK center is largely undertaken as an elective procedure. Children less than 1 year form an increasing patient group. Complications may be minimized by meticulous surgical technique and ensuring a comprehensive tracheostomy care program.
背景/目的：与成人相比，儿科患者的气管造口术具有更高的发病率和死亡率。本研究强调了一家英国儿童医院不断发展的经验。
确定了1995年至2004年间所有接受气管造口术的儿童。对适应证、并发症和结果进行了评估。
回顾了112名儿童（年龄范围为新生儿至18岁）的完整病例记录。适应证包括先天性出生缺陷——颅面疾病、食管闭锁、喉裂、囊性水瘤、血管畸形。后天性上气道病变（15.5%）和软化（12.1%）是其他标准。神经肌肉疾病（12.1%）或呼吸机依赖（26.7%）的患者长期通气也需要气管造口术。58例（50%）气管造口术是在1岁以下婴儿中进行的。109例为择期手术，仅7例（6%）用于紧急气道管理。发病率包括伤口问题（14例，14.4%）、导管移位或阻塞（14例，14.4%）、气管皮肤瘘（6例，6.2%）和气胸（4例，4.1%）。无急性出血并发症。两名儿童在导管意外移位/阻塞后死亡。
该英国中心的气管造口术主要作为择期手术进行。1岁以下儿童的患者群体在不断增加。通过精细的手术技术和确保全面的气管造口护理计划，并发症可能会降至最低。
