O'Connor J V, Reddy K, Ergin M A, Griepp R B
Ann Thorac Surg. 1985 Apr;39(4):353-4. doi: 10.1016/s0003-4975(10)62630-6.
Forty-nine patients required prolonged ventilatory support after cardiac operations. Cricothyroidotomy was used routinely in these patients after approximately 7 days of endotracheal intubation. There were no infections of the median sternotomy wounds despite frequent colonization of the stoma. The only immediate complication was mild stomal bleeding in a patient taking anticoagulants. Nineteen patients (39%) died of underlying disease. The average duration of cricothyroidotomy was 59 days (range, 3 to 270 days). Cannulas were successfully removed in all survivors after an average of 38 days (range, 6 to 187 days). All of the patients were followed by personal interview, telephone contact, or contact with the referring physician. The average length of follow-up was 17 months (range, 2 to 50 months). All symptomatic patients were evaluated by laryngoscopy and bronchoscopy. One patient required endoscopic removal of granulation tissue from the stomal site; 2 others required tracheal resection for stenosis at the balloon site. There were no instances of subglottic stenosis. There were 4 late deaths, none of which was related to the cricothyroidotomy. Based on these findings, we suggest that cricothyroidotomy, with its low complication rate, is the procedure of choice for patients requiring prolonged mechanical ventilation after cardiac operations.
49例患者在心脏手术后需要长期通气支持。在气管插管约7天后，这些患者常规进行环甲膜切开术。尽管造口处常有细菌定植，但正中胸骨切开伤口未发生感染。唯一的即刻并发症是1例服用抗凝剂的患者出现轻度造口出血。19例患者（39%）死于基础疾病。环甲膜切开术的平均持续时间为59天（范围3至270天）。所有幸存者平均38天（范围6至187天）后成功拔除套管。所有患者均通过个人面谈、电话联系或与转诊医生联系进行随访。平均随访时间为17个月（范围2至50个月）。所有有症状的患者均接受喉镜和支气管镜检查。1例患者需要在内镜下切除造口处的肉芽组织；另外2例患者因球囊部位狭窄需要进行气管切除。未发生声门下狭窄。有4例晚期死亡，均与环甲膜切开术无关。基于这些发现，我们认为环甲膜切开术并发症发生率低，是心脏手术后需要长期机械通气患者的首选手术方式。
