Issa M M, Healy D M, Maghur H A, Luke D A
Department of Surgery, Royal City of Dublin Hospital, Trinity College, School of Medicine, Ireland.
J Thorac Cardiovasc Surg. 1991 May;101(5):895-900.
Thirty consecutive patients undergoing lung resections were randomized into two groups: Group A (n = 15) received minitracheotomy postoperatively and group B (n = 15) were control patients. Postoperative respiratory course was monitored by serial clinical assessments, chest x-ray examination, arterial blood gases, sputa bacterial cultures, and the patient's requirement and response to chest physiotherpy. The two groups were similarly matched in age (mean 58.5 years), smoking habits, pulmonary functions, and surgical procedures. Postoperative pulmonary complications of collapse/consolidation developed in 11 patients (two in group A and nine in group B) (p less than 0.03). Four patients (all in group B) required nimitracheotomy in addition to antibiotics and chest physiotherapy to treat their pneumonia. Chest physiotherapy requirement was less in group A than in group B, with a mean number of sessions of seven in group A and eight in group B and a mean total time of 92 minutes in group A and 112 minutes in group B. The mean duration of minitracheotomy was 4.13 days. Minor temporary symptoms resulted from the minitracheotomy in eight patients (42%) and included discomfort, voice changes, subcutaneous emphysema, and stridor. There was one case of long-term morbidity (5%)-skin scarring from wound infection at the site of the minitracheotomy. No postoperative deaths resulted. We conclude that the prophylactic use of minitracheotomy is safe and effective in decreasing postoperative respiratory complications in patients undergoing lung resections.
30例连续接受肺切除术的患者被随机分为两组：A组（n = 15）术后接受微创气管切开术，B组（n = 15）为对照组。通过系列临床评估、胸部X线检查、动脉血气分析、痰液细菌培养以及患者对胸部物理治疗的需求和反应来监测术后呼吸过程。两组在年龄（平均58.5岁）、吸烟习惯、肺功能和手术操作方面匹配相似。11例患者发生了肺不张/实变的术后肺部并发症（A组2例，B组9例）（p < 0.03）。4例患者（均在B组）除抗生素和胸部物理治疗外还需要进行微创气管切开术来治疗肺炎。A组对胸部物理治疗的需求少于B组，A组平均治疗次数为7次，B组为8次；A组平均总时长为92分钟，B组为112分钟。微创气管切开术的平均持续时间为4.13天。8例患者（42%）因微创气管切开术出现轻微短暂症状，包括不适、声音改变、皮下气肿和喘鸣。有1例长期并发症（5%）——微创气管切开术部位伤口感染导致皮肤瘢痕形成。无术后死亡病例。我们得出结论，预防性使用微创气管切开术对于减少接受肺切除术患者的术后呼吸并发症是安全有效的。
