Viau F, Lededente A, Le Tinier J Y
Service de Pneumologie, CMC de Bligny, Briis-sous-Forges.
Rev Pneumol Clin. 1988;44(1):24-32.
The complications of tracheotomy are reviewed and divided into two categories: early and late complications depending on whether the cannula has been removed or remains in situ. In the acute period, severe haemorrhages (0.3 to 2%) and oesophagotracheal fistulae (0.5 to 2%) result from a conflict between cannula and trachea during prolonged intensive care. Cardiac arrhythmia is frequent during aspiration (35%) but rarely lethal. Various technical problems related to the tracheotomy material are common (4 to 6%) and often very serious. Air leakage is represented mainly by severe pneumothorax (1 to 5%) under artificial ventilation. Tracheotomy wound infections (0.5 to 3.5%) may facilitate pulmonary superinfections (15 to 30%) which have a 5 to 8.5% mortality rate. In the acute phase, the overall mortality rate due to the tracheotomy itself is 1.7% (40 deaths in the 2,692 tracheotomies reviewed). The main post-decannulation complication is tracheal stenosis. The incidence of severe stenosis (more than two-thirds of the tracheal diameter) varies from 8 to 12%. Stenosis is difficult to diagnose unless endoscopic examination is routinely performed. The classical treatment is surgical, but laser is helpful in this as in granulomas. In patients with in-dwelling cannula, granulomas may be responsible for pain, obstruction and bleeding which can be avoided by using an adequate equipment. Chronic invasion of the bronchi by Gram-negative organisms is almost constant and results in episodes of superinfection. Finally, patients with a permanent cannula often have psychological and social problems influencing their quality of life.
根据套管是否已拔除或仍留在原位，分为早期和晚期并发症。在急性期，长时间重症监护期间，套管与气管之间的冲突会导致严重出血（0.3%至2%）和食管气管瘘（0.5%至2%）。吸痰时心律失常很常见（35%），但很少致命。与气管切开术材料相关的各种技术问题很常见（4%至6%），且往往非常严重。漏气主要表现为人工通气下严重气胸（1%至5%）。气管切开伤口感染（0.5%至3.5%）可能促使肺部发生二重感染（15%至30%），其死亡率为5%至8.5%。在急性期，气管切开术本身导致的总体死亡率为1.7%（在2692例回顾的气管切开术中，有40例死亡）。拔管后的主要并发症是气管狭窄。严重狭窄（超过气管直径的三分之二）的发生率为8%至12%。除非常规进行内镜检查，否则狭窄很难诊断。经典的治疗方法是手术，但激光在治疗狭窄和肉芽肿方面很有帮助。对于留置套管的患者，肉芽肿可能导致疼痛、梗阻和出血，使用合适的设备可避免这些情况。革兰氏阴性菌对支气管的慢性侵袭几乎持续存在，并导致二重感染发作。最后，永久性套管患者常常存在影响其生活质量的心理和社会问题。
