Au J, Walker W S, Inglis D, Cameron E W
Department of Thoracic Surgery, City Hospital, Edinburgh, Scotland.
Ann Thorac Surg. 1989 Dec;48(6):850-2. doi: 10.1016/0003-4975(89)90684-x.
In the period 1984 to 1988, 2,448 patients underwent major thoracic operations in our unit. Of these patients, 144 (5.9%) underwent percutaneous cricothyroidostomy (minitracheostomy) using a 20F pediatric silver tracheostomy tube. Minitracheostomies were performed for the treatment of sputum retention in 81 patients, prophylactically in 62 patients, and as a route for high-frequency jet ventilation in 1 patient. Minitracheostomy tubes remained in situ a median of four days. Suction function was satisfactory in 99% of patients, with only 2 patients requiring subsequent suction bronchoscopy and no occurrence of tube blockage. Ninety-four percent of minitracheostomies performed were entirely uneventful. Bleeding was the most common complication (3.5%), and no instances of subglottic stenosis have occurred. During the review period, there was a significant increase in the percentage of patients requiring major operations undergoing prophylactic, but not therapeutic, minitracheostomy (p less than 0.001). This was associated with a significant decrease in the percentage of patients requiring suction bronchoscopy (p less than 0.001). We conclude that prophylactic minitracheostomy with the 20F pediatric silver tracheostomy tube is a safe and effective procedure in the prevention of postoperative sputum retention.
在1984年至1988年期间，我们科室有2448例患者接受了胸科大手术。其中，144例（5.9%）使用20F小儿银质气管造口管进行了经皮环甲膜切开术（微型气管造口术）。81例患者进行微型气管造口术是为了治疗痰液潴留，62例为预防性操作，1例作为高频喷射通气的途径。微型气管造口管留置的中位时间为4天。99%的患者吸痰功能良好，只有2例患者随后需要进行吸痰支气管镜检查，且未发生导管堵塞。94%的微型气管造口术操作完全顺利。出血是最常见的并发症（3.5%），未发生声门下狭窄病例。在回顾期内，需要进行大手术的患者中，接受预防性而非治疗性微型气管造口术的比例显著增加（p<0.001）。这与需要进行吸痰支气管镜检查的患者比例显著下降相关（p<0.001）。我们得出结论，使用20F小儿银质气管造口管进行预防性微型气管造口术是预防术后痰液潴留的一种安全有效的方法。
