Luo Chunmei, Yang Hongli, Chen Yu, Zhang Zhengfeng, Gong Zili
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao Street, Shapingba District, Chongqing, 400037, China.
Cell Biochem Biophys. 2014 Sep;70(1):455-9. doi: 10.1007/s12013-014-9940-5.
Tracheostomy is frequently performed in severe cervical spinal cord injury (SCI) patients with the pulmonary dysfunction. A series of respiratory nursing interventions are required to plan tracheostomy removal. Tracheostomy was performed in 29 patients after acute traumatic cervical SCI. A series of respiratory nursing interventions were introduced in these patients after closed tracheostomy and decannulation, including closed tracheostomy tube training, manually assisted cough. Chacheostomy was successfully removed in 21 patients after the respiratory nursing interventions. In contrast, eight patients died from associated injuries. The average time from tracheostomy to decannulation was 40 days (14-104 days), the average time from closed tracheostomy to decannulation was 18.80 ± 13.50 days. Second tracheostomy was performed in one patient after 29 days' removal due to pulmonary infection. One patient presented with delayed incision healing for 29 days. Closed tracheostomy tube training and manually assisted cough are key factors for tracheostomy removal, although intensive nursing are also needed. The time from tracheostomy to decannulation and from closed tracheostomy to decannulation is increased in case of "late" (>24 h) tracheostomy and longer mechanical ventilation.
气管切开术常用于患有肺功能障碍的严重颈脊髓损伤（SCI）患者。需要一系列呼吸护理干预措施来计划拔除气管切开管。29例急性创伤性颈脊髓损伤患者接受了气管切开术。在这些患者进行气管切开闭合和拔管后，引入了一系列呼吸护理干预措施，包括气管切开闭合管训练、人工辅助咳嗽。经过呼吸护理干预后，21例患者成功拔除气管切开管。相比之下，8例患者死于相关损伤。气管切开至拔管的平均时间为40天（14 - 104天），气管切开闭合至拔管的平均时间为18.80±13.50天。1例患者在拔除气管切开管29天后因肺部感染进行了二次气管切开术。1例患者切口愈合延迟29天。气管切开闭合管训练和人工辅助咳嗽是拔除气管切开管的关键因素，尽管也需要强化护理。如果进行“晚期”（>24小时）气管切开术和较长时间的机械通气，气管切开至拔管以及气管切开闭合至拔管的时间会延长。
